Bone plate with movable joint

ABSTRACT

System, including methods and devices, for fixing bone. The system may include a bone plate having two or more plate members connected to one another with one or more movable joints. Each joint may permit the orientation of the plate members to be adjusted relative to one another in a single plane or two or more nonparallel planes. The joint may have a movable configuration and a fixed configuration. Methods of creating the bone plate are also provided.

CROSS-REFERENCES TO PRIORITY APPLICATIONS

This application is based upon and claims the benefit under 35 U.S.C. §119(e) of U.S. Provisional Patent Application Ser. No. 62/020,691, filedJul. 3, 2014; and U.S. Provisional Patent Application Ser. No.62/110,220, filed Jan. 30, 2015. Each of these priority applications isincorporated herein by reference in its entirety for all purposes.

INTRODUCTION

The human skeleton is composed of 206 individual bones that perform avariety of important functions, including support, movement, protection,storage of minerals, and formation of blood cells. These bones can begrouped into two categories, the axial skeleton and the appendicularskeleton. The axial skeleton consists of 80 bones that make up thebody's center of gravity, and the appendicular skeleton consists of 126bones that make up the body's appendages. The axial skeleton includesthe skull, vertebral column, ribs, and sternum, among others, and theappendicular skeleton includes the long bones of the upper and lowerlimbs, and the clavicles and other bones that attach these long bones tothe axial skeleton, among others.

To ensure that the skeleton retains its ability to perform its importantfunctions, and to reduce pain and disfigurement, fractured bones shouldbe repaired promptly and properly. Typically, fractured bones aretreated using a fixation device that reinforces the bone and keeps bonefragments aligned during healing. Fixation devices may take a variety offorms, including casts for external fixation and bone plates forinternal fixation, among others. Bone plates are implantable devicesthat can be mounted on bone with the plate spanning a fracture. To use abone plate to repair a fractured bone, a surgeon (1) selects anappropriate plate, (2) reduces (sets) the fracture, and (3) attaches theplate to opposite sides of the fracture using suitable fasteners, suchas bone screws, so that pieces of the bone are fixed relative to oneanother.

The bone plate often is formed integrally as one piece and then is bentintraoperatively by a surgeon to custom-fit the bone plate to asubject's bone. However, bending a unitary bone plate has variousdisadvantages. For example, bending can be time-consuming, can weakenthe bone plate, may be difficult to control for small changes to theplate shape, and/or can be particularly challenging for in-planedeformation of the bone plate where the plate is generally mostresistant to deformation.

Bone plates having two or more discrete plate segments connected to oneanother by at least one joint are known. These jointed bone plates solvevarious problems posed by one-piece bone plates. However, jointed boneplates need to be improved to compete effectively with the simplicityand familiarity of a unitary bone plate.

SUMMARY

The present disclosure provides a system, including methods and devices,for fixing bone. The system may include a bone plate having two or moreplate members connected to one another with one or more movable joints.Each joint may permit the orientation of the plate members to beadjusted relative to one another in a single plane or two or morenonparallel planes. The joint may have a movable configuration and afixed configuration. Methods of creating the bone plate are alsoprovided.

BRIEF DESCRIPTION OF THE DRAWINGS

FIG. 1 is a schematic view of an exemplary bone plate having a movablejoint connecting a pair of plate members and attached to a broken bone,and illustrating exemplary plate member movements permitted by a jointof the present disclosure.

FIG. 2 is a plan view of an exemplary bone plate for fixation of aclavicle and having a pair of rotatable joints spaced along the boneplate from one another, with each joint being a hinge joint that ismovable about a rotation axis arranged transverse to a plane defined bythe bone plate, to allow adjustment of the longitudinal shape of thebone plate, in accordance with aspects of the present disclosure.

FIG. 3 is a lateral view of the bone plate of FIG. 2.

FIG. 4 is a bottom, fragmentary view of an end portion of the bone plateof FIG. 2, taken generally along line 4-4 of FIG. 3.

FIG. 5 is an exploded view of the bone plate of FIG. 2 showing the threesegments (plate members) of the bone plate that are attached to oneanother by hinge joints.

FIG. 6 is a schematic sectional view of the bone plate of FIG. 2, takengenerally along line 6-6 of FIG. 2 through one of the hinge joints ofthe bone plate before (panel A) and after (panel B) an axle of the jointis deformed to capture another plate member of the bone plate on theaxle, in accordance with aspects of the present disclosure.

FIG. 7 is a fragmentary plan view of an exemplary bone plate having ahinge joint that is lockable with a locking member located at a positionspaced from the pivot axis of the hinge joint, in accordance withaspects of the present disclosure.

FIG. 8 is a longitudinal sectional view of the bone plate of FIG. 7,taken generally along line 8-8 of FIG. 7 through the hinge joint and thelocking member.

FIG. 9 a longitudinal sectional view taken as in FIG. 8 with the hingejoint locked with a different locking member.

FIG. 10 is a fragmentary plan view of an exemplary bone plate having ahinge joint locked with a connector, with plate members of the boneplate fitted together via a pair of arcuate, complementary matingregions centered around and bracketing the pivot axis of the hingejoint.

FIG. 11 is a longitudinal sectional view of the bone plate of FIG. 10,taken generally along line 11-11 of FIG. 10.

FIG. 12 is a longitudinal sectional view of an exemplary bone platehaving a hinge joint that is lockable with an expandable collet, shownin the unlocked configuration before collet expansion.

FIG. 13 is a view of the bone plate of FIG. 12, taken as in FIG. 12after expansion of the collet with a fastener to lock the hinge joint.

FIG. 14A is a plan view of an exemplary bone plate for fixation of thedistal radius, with the bone plate having a segmented shaft including ahinge joint.

FIG. 14B is a sectional view of the bone plate of FIG. 14A, takengenerally along line 14B-14B of FIG. 14 through the hinge joint.

FIGS. 15A-15E are schematic, fragmentary sectional views of exemplarybone plates having a multi-axis joint, taken through the joint beforeand after placement of the joint in a fixed configuration, andillustrating various arrangements and interactions of protrusions,voids, and deformable elements, in accordance with aspects of thepresent disclosure.

FIG. 16 is an exploded view of another exemplary bone plate for fixationof the distal radius, with the bone plate having a multi-axis jointconnecting a head to a shaft of the bone plate, and with the multi-axisjoint having a pair of deformable elements and a set of teeth thatdeform the deformable elements as the joint is locked by manipulation ofa connector.

FIG. 17 is a plan view of the bone plate of FIG. 16 taken with the boneplate assembled.

FIG. 18 is a fragmentary bottom view of the bone plate of FIG. 16, takengenerally around the multi-axis joint with the bone plate assembled.

FIG. 19 is a fragmentary, longitudinal sectional view of the bone plateof FIG. 16, taken generally along line 19-19 of FIG. 17 centrallythrough the multi-axis joint.

FIG. 20 is another fragmentary, longitudinal sectional view of the boneplate of FIG. 16, taken generally along line 20-20 of FIG. 17 laterallythrough the multi-axis joint.

FIG. 21 is a fragmentary, cross-sectional view of the bone plate of FIG.16, taken generally along line 21-21 of FIG. 17 centrally through themulti-axis joint.

FIG. 22 is a plan view of another exemplary bone plate for fixation ofthe distal radius, with the bone plate having a multi-axis jointgenerally as in FIG. 16 but with a connector that is inverted withrespect to the bone plate of FIG. 16.

FIG. 23 is a fragmentary bottom view of the bone plate of FIG. 22.

FIG. 24 is a fragmentary bottom view of a shaft plate member of the boneplate of FIG. 23, taken in the presence of a pair of deformable elementsof the plate member and in the absence of a head plate member of thebone plate.

FIG. 25 is a plan view of the head plate member of the bone plate ofFIG. 23, taken in the absence of the shaft plate member and thedeformable elements of FIG. 24.

FIG. 26 is a fragmentary, longitudinal sectional view of the bone plateof FIG. 22, taken generally along line 26-26 of FIG. 22 through a centerof the multi-axis joint.

FIG. 26A is a fragmentary, longitudinal sectional view of the bone plateof FIG. 22, taken generally along line 26A-26A of FIG. 22 laterallythrough the multi-axis joint.

FIG. 27 is a fragmentary, longitudinal sectional view of anotherexemplary bone plate having a multi-axis joint, taken generally as inFIG. 26, with the multi-axis joint having a curvature that is invertedwith respect to the bone plate of FIG. 26.

FIG. 27A is a fragmentary, longitudinal sectional view of the bone plateof FIG. 27, taken generally as in FIG. 26A for comparison with the boneplate of FIG. 26.

FIG. 28 is a simplified plan view of yet another exemplary bone platefor fixation of the distal radius, with the bone plate having amulti-axis joint formed at an interface between a head plate member anda shaft plate member of the bone plate, and with the range of motionpermitted by the joint governed by a triangular stop region, inaccordance with aspects of the present disclosure.

FIG. 29 is a plan view of selected aspects of still another exemplarybone plate for fixation of the distal radius and having a multi-axisjoint, taken in the absence of a connector for the joint, in accordancewith aspects of the present disclosure.

FIG. 30 is a fragmentary sectional view of a shaft plate member of thebone plate of FIG. 29, taken generally along line 30-30 around themulti-axis joint and illustrating an exemplary pattern created by voidsformed in a surface of the joint.

FIG. 31 is a fragmentary sectional view of another exemplary shaft platemember for the bone plate of FIG. 29, taken generally as in FIG. 30 andillustrating another exemplary pattern created by voids formed in asurface of the joint.

FIG. 32 is a fragmentary sectional view of yet another exemplary shaftplate member for the bone plate of FIG. 29, taken generally as in FIG.31 and illustrating yet another exemplary pattern created by voidsformed in a surface of the joint.

FIG. 33 is a fragmentary sectional view of a head plate member of thebone plate of FIG. 29, taken generally around the multi-axis joint withthe head plate member generally inverted with respect to FIG. 29 andillustrating an exemplary joint surface including a protrusion forcontact with any of the joint surfaces of FIGS. 30-32.

FIGS. 34 and 35 are fragmentary sectional views of other exemplary headplate members for the bone plate of FIG. 29, taken as in FIG. 33 andillustrating other exemplary joint surfaces including a protrusion forcontact with any of the joint surfaces of FIGS. 30-32.

FIG. 36 is a plan view of selected aspects of still yet anotherexemplary bone plate for fixation of the distal radius and having amulti-axis joint, taken in the absence of a connector for the joint,with the bone plate having a head portion with a pair of transverselyarranged head regions that are movable with respect to one another viathe multi-axis joint, in accordance with aspects of the presentdisclosure.

FIG. 37 is a plan view of an exemplary bone plate having a generallycylindrical joint that permits changing the orientation of a head platemember and a shaft plate member of the bone plate relative to oneanother in a plane that is at least generally parallel to the long axisof the bone plate and transverse (e.g., orthogonal) to a plane definedby the bone plate, in accordance with aspects of the present disclosure.

FIG. 38 is a side view of the bone plate of FIG. 37, taken generallyalong line 38-38 of FIG. 37, and illustrating movement of the head platemember relative to the shaft plate member in phantom.

FIG. 39 is a fragmentary, sectional view of the bone plate of FIG. 37,taken generally along line 39-39 of FIG. 37 through the cylindricaljoint.

FIG. 40 is a view of another exemplary bone plate having a generallycylindrical joint, taken from above the bone plate, with the curvatureof the joint inverted relative to the bone plate of FIG. 37, and withthe connector of the joint removed.

FIG. 41 is a fragmentary, exploded view of the bone plate of FIG. 40,taken around the generally cylindrical joint and with the plate membersrotated relative to one another such that both joint surfaces of theplate members are visible.

FIG. 42 is a pair of fragmentary, sectional views of the bone plate ofFIG. 40, taken generally along line 42-42 of FIG. 40 in the presence ofthe connector for the generally cylindrical joint and illustrating twodifferent orientations of the plate members in panels A and B, with theorientations produced by inter-fitting joint surfaces together indifferent registers of complementary surface features.

FIG. 43 is an exploded, fragmentary view of yet another exemplary boneplate having a generally cylindrical joint, taken generally as in FIG.41, with the joint utilizing deformable elements in place of teeth toprevent movement of the plate members relative to one another in thefixed configuration of the joint, in accordance with aspects of thepresent disclosure.

FIG. 44 is a pair of fragmentary, sectional views of an exemplary boneplate having a generally planar joint that permits translationaladjustment of plate member positions relative to one another, takengenerally as in FIG. 42 and illustrating two different positions of theplate member in panels A and B produced by inter-fitting joint surfacestogether in different registers of complementary surface features.

FIG. 45 is an exploded view of an exemplary bone plate including alockable hinge joint having a rotation axis arranged transverse to aplane defined by the bone plate, with the hinge joint including adeformable element, in accordance with aspects of the presentdisclosure.

FIG. 46 is a pair of fragmentary plan views of the bone plate of FIG.45, taken generally around the hinge joint and illustrating twodifferent orientations of the plate members of the bone plate in panelsA and B.

FIG. 47 is a sectional view of the bone plate of FIG. 45, takengenerally along line 47-47 of FIG. 46.

FIG. 48 is a plan view of an exemplary bone plate including a generallycylindrical joint having a rotation axis arranged at least generallyparallel to a long axis defined by the bone plate, in accordance withaspects of the present disclosure.

FIG. 49 is an end view of the bone plate of FIG. 48, taken generallyalong line 49-49 of FIG. 48 and illustrating phantom movement of piecesof the plate relative to one another about the rotation axis.

FIG. 50 is a fragmentary, bottom view of the bone plate of FIG. 48,taken generally around the cylindrical joint.

FIG. 51 is a fragmentary, exploded view of the bone plate of FIG. 48,taken generally around the cylindrical joint with a head plate memberinverted with respect to a shaft plate member of the bone plate.

FIG. 52 is a sectional view of the bone plate of FIG. 48, takengenerally along line 52-52 of FIG. 50 through the cylindrical joint.

FIG. 53 is a sectional view of another exemplary bone plate having agenerally cylindrical (single-axis) joint oriented generally as in thebone plate of FIG. 48, with the cylindrical joint having complementarysurface features defined by a pair of joint surfaces and configured tofit together in a plurality of discrete registers, in accordance withaspects of the present disclosure.

FIG. 54 is a plan view of an exemplary bone plate having a closed(non-cannulated) hinge joint and an open (cannulated) hinge jointconnecting three plate members to one another end-to-end, with the boneplate positioned on a lateral region of a clavicle before attachmentwith fasteners (such as bone screws), and with in-plane rotationalmotion of the two end plate members shown in phantom, in accordance withaspects of the present disclosure.

FIG. 55 is a bottom view of the bone plate of FIG. 54, taken in theabsence of the clavicle.

FIG. 56 is a fragmentary sectional view of the bone plate of FIG. 54,taken generally along line 56-56 of FIG. 55 through an end region of thebone plate and showing a notch formed in a bottom surface of the boneplate to enable out-of-plane deformation of the end region.

FIG. 57 is a plan view of an exemplary bone plate having a pair of openhinge joints connecting three plate members to one another end-to-end,with the bone plate positioned on a longitudinally central region of aclavicle before attachment with fasteners, with pivotal motion of thetwo end plate members shown in phantom, and with each hinge joint beingformed only by integral portions of a pair of adjacent plate members, inaccordance with aspects of the present disclosure.

FIG. 58 is a fragmentary sectional view of the bone plate of FIG. 57,taken generally along line 58-58 of FIG. 57 through one of the hingejoints.

FIG. 59 is a fragmentary bottom view of the bone plate of FIG. 57, takengenerally along line 59-59 of FIG. 58 toward one of the hinge joints.

FIG. 60 is a fragmentary sectional view of a bone plate having a closedcounterpart of the open hinge joint of FIG. 58, taken generally as inFIG. 58 through the hinge joint, in accordance with aspects of thepresent disclosure.

FIG. 61 is a plan view of an exemplary bone plate having a pair ofclosed hinge joints connecting three plate members end-to-end, with eachhinge joint including a connector having an external thread, inaccordance with aspects of the present disclosure.

FIG. 62 is a fragmentary sectional view of the bone plate of FIG. 61,taken generally along line 62-62 of FIG. 61 through one of the hingejoints.

FIG. 63 is a plan view of another exemplary bone plate having a pair ofopen hinge joints connecting three plate members end-to-end, with eachhinge joint including a cannulated connector having an external threadand defining a through-hole to receive a fastener that extends intounderlying bone, in accordance with aspects of the present disclosure.

FIG. 64 is a fragmentary sectional view of the bone plate of FIG. 63,taken generally along line 64-64 of FIG. 63 through one of the hingejoints.

FIG. 65 is a fragmentary plan view of the bone plate of FIG. 63, takengenerally around the region indicated at “65” in FIG. 63.

FIG. 66 is a fragmentary bottom view of a bone plate having a hingejoint with a range of pivotal motion determined by a pin received in aslot, with the range of pivotal motion preventing rotational disassemblyof mated plate members of the hinge joint such that the plate membersare permanently connected to one another, in accordance with aspects ofthe present disclosure.

FIG. 67 is a fragmentary sectional view of the bone plate of FIG. 66,taken generally along line 67-67 of FIG. 66 through the joint afterinstallation of a connector in a pair of aligned apertures defined bythe plate members, in accordance with aspects of the present disclosure.

FIG. 68 is fragmentary plan view of an exemplary bone plate having anopen hinge joint in which a connector having flexible locking tabs isheld in place by a snap-fit attachment, in accordance with aspects ofthe present disclosure.

FIG. 69 is fragmentary sectional view of the bone plate of FIG. 68,taken generally along line 69-69 of FIG. 68.

FIG. 70 is a fragmentary, bottom view of the bone plate of FIG. 68,taken generally along line 70-70 of FIG. 69.

FIG. 71 is a view of the bone plate of FIG. 57 engaged by a pair oftools positioned on opposite sides of one of the hinge joints, with thetools are being used to apply torque to rotate plate members relative toone another, to adjust an orientation of the plate members, inaccordance with aspects of the present disclosure.

FIG. 72 is a view of an exemplary bone plate for fixation of the distalradius, with the bone plate having a multi-axis joint connecting a headplate member to a shaft plate member of the bone plate, and with theshaft plate member having a pair of deformable elements forming part ofone of the joint surfaces of the joint and attached to a body of theshaft plate member, in accordance with aspects of the presentdisclosure.

FIG. 73 is an exploded side view of the bone plate of FIG. 72, takenfrom below the bone plate.

FIG. 74 is another exploded side view of the bone plate of FIG. 72,taken from above the bone plate.

FIG. 75 is a fragmentary plan view of the bone plate of FIG. 72, takenwith the head plate member of the bone plate in three differentorientations permitted by the multi-axis joint and achieved by movingthe head plate member in a plane that is parallel to the long axis ofthe shaft plate member and perpendicular to a plane defined by the shaftplate member, with the shaft plate member of the bone plate stationaryto illustrate how the three different orientations change the length ofthe bone plate.

FIG. 76 is a fragmentary, partially sectional view of the bone plate ofFIG. 72, taken generally along line 76-76 of FIG. 75.

FIG. 77 is a fragmentary bottom view of a shaft plate member of stillanother exemplary bone plate for fixation of the distal radius, with thebone plate having a multi-axis joint connecting a head plate member tothe shaft plate member, and with the head plate member including a jointsurface forming a pair of protrusions that contact a pair of deformableelements of the joint surface of the shaft plate member, in accordancewith aspects of the present disclosure.

FIG. 78 is a plan view of yet another exemplary bone plate for fixationof the distal radius, with the bone plate having a multi-axis jointconnecting a head plate member to a shaft plate member, and with thejoint having discrete adjustability in a first plane and continuousadjustability in a second plane that is nonparallel to the first plane,in accordance with aspects of the present disclosure.

FIG. 79 is a fragmentary view of the shaft plate member of the boneplate of FIG. 78, taken from above the shaft plate member.

FIG. 80 is a fragmentary bottom view of the head plate member of thebone plate of FIG. 78.

FIG. 81 is a sectional view of the bone plate of FIG. 78, takengenerally along line 81-81 of FIG. 78.

FIGS. 82-86 are a series of views of an exemplary bone plate forfixation of the proximal humerus, with the bone plate attached to aproximal humerus (fasteners are not shown) and having a multi-axis jointconnecting a head plate member to a shaft plate member of the boneplate, and with the head plate member in various orientations relativeto the shaft plate member, to show how the multi-axis joint can be usedto adjust fracture reduction, in accordance with aspects of the presentdisclosure.

DETAILED DESCRIPTION

The present disclosure provides a system, including methods and devices,for fixing bone. The system may include a bone plate having two or moreplate members connected to one another with one or more movable joints.Each joint may permit the orientation of the plate members to beadjusted relative to one another in a single plane or two or morenonparallel planes. The joint may have a movable configuration and afixed configuration. Methods of creating the bone plate are alsoprovided.

Each joint may permit in-plane motion and/or out-of-plane motion (e.g.,bending and/or twisting) of a pair of plate members connected to eachother at the joint. The joint also or alternatively may permitadjustment of the length of the bone plate, via displacement of theplate members relative to one another at the joint. Each joint may ormay not be lockable to create a rigid coupling of the plate members toone another (a fixed configuration), such as by compression applied atthe joint with a discrete connector and/or via installation/adjustmentof one or more fasteners disposed at one or more positions spaced fromthe joint.

In some embodiments, each joint may be a hinge joint. The hinge jointmay be bracketed by a pair of locking through-holes configured toreceive locking bone screws, with the bone plate optionally including atleast two hinge joints and/or marked to indicate an axial zone foroverlap with a fracture.

An exemplary bone plate is provided. The bone plate may include a pairof plate members connected to one another by a hinge joint defining apivot axis. The plate members may be rotatable relative to one anotherin-plane about the pivot axis. The plate members may or may not bepermanently connected to one another. In some embodiments, one of theplate members has an integrally-formed axle disposed in an aperture ofthe other plate member to create the hinge joint. The axle may becaptured in the aperture, to permanently connect the plate members, bydeforming the axle to create a retainer, or by welding a retainer to theaxle, among others. The hinge joint may not be adjustable off-bonebetween movable and fixed configurations, and may require at least onetool for applying torque to rotate the plate members. In someembodiments, the bone plate may define a through-hole that is coaxialwith the pivot axis and configured to receive a fastener that attachesthe hinge joint to bone. The through-hole may or may not have aninternal thread. In some embodiments, a pin in a slot determines thepermitted range of rotation of the plate members about the pivot axis.In some embodiments, the plate members may have complementary featuresthat create an interface. Portions of one of the plate members may belocated directly under and directly over a portion of the other platemember at the interface, along a line parallel to the pivot axis, whichmay increase the bending strength of the bone plate at the hinge joint.In some embodiments, the plate members may be connected to one anotherwith a discrete connector. The connector may be in threaded engagementwith one of the plate members and may be manipulated to change the hingejoint between movable and fixed configurations. The connector may have ahead under a shaft, and may have a left-handed external thread. Removalof the connector may be obstructed by a flange of one of the platemembers, to permanently connect the plate members to one another. Insome embodiments, the connector may have a snap-fit attachment to theplate members. A locking member may be receiving in an opening of theconnector, and adjusted to radially expand a region of the connector toplace the hinge joint in a fixed configuration.

In some embodiments, the bone plate may include a multi-axis jointhaving joint surfaces formed by a pair of plate members. At least one ofthe plate members may include a body and a discrete deformable element.The deformable element may form at least part of one joint surface. Thedeformable element may be deformed by contact with the other jointsurface, when the joint is placed in a fixed configuration. In someembodiments, the deformable element may extend into a void defined bythe other joint surface, before and/or after the joint is placed in afixed configuration. In some embodiments, a protrusion defined by theother joint surface may deform the deformable element when the joint isplaced in a fixed configuration.

In some embodiments, the bone plate may include a multi-axis jointhaving joint surfaces formed by a first plate member and a second platemember. The joint surface of the first plate member may include aprotrusion, and the joint surface of the second plate member may defineone or more voids. Each protrusion may deform and/or be deformed by thejoint surface of the second plate member when the joint is placed in afixed configuration, such that the protrusion extends into or moredeeply into at least one void.

In some embodiments, the bone plate may include a multi-axis jointconnecting a pair of plate members. The joint may have a movableconfiguration that allows an orientation of the plate members to becontinuously adjusted in a first plane and discretely adjusted in asecond plane that is transverse (e.g., orthogonal) to the first plane.The joint may include complementary, spherical surface regions and aratchet. The ratchet may or may not selectively restrict rotation in oneof two opposite rotational directions in the second plane. One of theplate members may form a tab. Movement of the tab may be stopped bycontact with the other plate member to define a range of permittedrotation in the first plane. Alternatively, or in addition, the tab maybe visible from above the bone plate and may be an indicator of theorientation of the plate members in the first plane.

In any embodiment of a bone plate having a multi-axis joint, the jointmay have a limited range of motion, which may be determined by aprojection of one plate member extending into an aperture defined byanother plate member. The aperture also may receive part of a connectorthat connects the plate members to one another.

In any embodiment of a bone plate having a multi-axis joint, the boneplate may include a connector that connects the plate members to oneanother. The connector may have a head under a shaft. The connector mayinclude an external, left-handed thread. The shaft may form a driverinterface for a suitable driver to adjust the connector from above thebone plate.

Further aspects of the fixation systems are described in the followingsections: (I) overview of bone plates with movable joints, (II) boneplates with single-axis joints, (III) bone plates with multi-axisjoints, (IV) bone plates with single joints for out-of-plane angularadjustment, (V) bone plates with joints to adjust translational offset,(VI) methods of bone fixation, and (VII) examples.

I. Overview of Bone Plates with Movable Joints

This section provides an overview of bone plates with movable joints;see FIG. 1.

FIG. 1 shows a schematic view of an exemplary bone plate 80 having amovable joint 82 (also called a movable connection) connecting a pair ofplate members 84, 86. Each plate member may be mounted (e.g., separatelymounted) to a bone 88 using one or more fasteners 90 (such as bonescrews, pins, wires, rivets, etc.). Each fastener may be received in athrough-hole (interchangeably termed an opening) defined by the platemember, and extends into the bone. (The plate member interchangeably maybe called a plate, a plate piece, or a mounting member.) Bone 88 mayhave at least one discontinuity, such as a fracture 93 or cut, spannedby the bone plate. Joint 82 may overlap the discontinuity, as shownhere, or may be offset along the bone from the discontinuity. Bone plate80 interchangeably may be termed a fixation device or a bone plateassembly.

Exemplary relative movements of plate members 84, 86 that may bepermitted by movable joint 82 are illustrated in phantom and identifiedby motion arrows 94, 96. The plate members may be movable relative toone another in at least one plane and/or about at least one rotationaxis, indicated by a rotation arrow 94, to change the angularorientation of the plate members relative to one another. Rotation maybe in-plane or out-of-plane with respect to a plane defined by the boneplate, and may be about a long axis of the bone plate and/or platemember or about another axis. The plate members also or alternativelymay be adjustable relative to one another along at least onedisplacement axis, indicated by a displacement arrow 96. Thedisplacement axis may or may not be linear, to provide net translationaldisplacement without or with rotation of the plate members relative toone another.

Rotation or movement of plate members relative to one another that is“in-plane” occurs in a plane that is at least generally parallel to aplane defined by one or more of the plate members. The in-plane movementmay, for example, be within about 20, 10, 5, 2, or 1 degree(s) ofperfectly parallel to the plane defined by the one or more of the platemembers. Single-axis joints (e.g., hinge joints) and multi-axis jointsmay permit in-plane rotation.

Each rotation axis (and/or plane in which rotation occurs) may have anysuitable position and orientation with respect to the bone plate. Therotation axis may be fixed or variable with respect to one or both platemembers. If variable, the position of the rotation axis may changebefore or during rotation of the plate members to change their angularorientation. The rotation axis may or may not pass through bone plate 80and/or joint 82. Whether or not the rotation axis passes through thebone plate or joint, the rotation axis may have any suitablerelationship to a plane (e.g., a length-width plane) and/or a long axisdefined by the bone plate and/or at least one plate member. The rotationaxis may be transverse (e.g., substantially or at least generallyperpendicular), or substantially or at least generally parallel to theplane or long axis. For example, the rotation axis may be within about20, 10, 5, 2, or 1 degree(s) of perfectly parallel or perfectlyperpendicular.

Each translational displacement axis may have any suitable orientationwith respect to the bone plate. The displacement axis may be at leastgenerally or substantially parallel, transverse (e.g., perpendicular),or oblique to the plane and/or long axis defined by the bone plateand/or at least one plate member. Accordingly, net movement of the platemembers relative to one another parallel to the displacement axis maychange a longitudinal offset and/or a transverse offset of the platemembers relative to one another. Both offsets can be changed at the sametime if the displacement axis is oblique to each of the characteristicorthogonal axes defined by the bone plate or a plate member thereof. Inany event, the transverse offset may be adjustable in a plane at leastgenerally or substantially parallel to a plane defined by the bone plateand/or at least one plate member, and/or in a plane that is oblique orat least generally or substantially perpendicular to the plane definedby the bone plate.

The bone plate may have any suitable number of plate members, and numberand position(s) of movable joints connecting the plate members to oneanother (e.g., connecting the plate members end-to-end). For example,the bone plate may have 2, 3, 4, or more plate members and/or 1, 2, 3,or more movable joints. In some embodiments, the bone plate may have Nplate members and N−1 movable joints. If the bone plate has more thanone movable joint, the joints may have any suitable position relative toone another, such as spaced along the long axis of the bone plate fromone another, or spaced obliquely or perpendicular to the long axis. Eachmovable joint may be located at any suitable position with respect to apair of plate members that are connected to one another by the joint.The joint may be located near the end of each of the plate members ormay be spaced substantially from the opposite ends of at least one ofthe plate members.

The plate members may or may not be permanently connected to one anotherat a movable joint. A permanent connection between plate members may becreated during manufacture of a bone plate, such that the plate membersalways remain connected to one another during normal handling andinstallation. Plate members that are permanently connected to oneanother are designed never to be accidentally disassembled by a user.The plate members cannot be completely separated from one anotherwithout damaging the bone plate (e.g., by cutting, breaking, plasticallydeforming, melting, or the like, a region of the bone plate), or withoutthe use of one or more tools unrelated to installation or adjustment ofthe bone plate. A bone plate with plate members that are permanentlyconnected to one another at a hinge joint offers the advantage of ahinged bone plate without the risk of dropping or losing a piece of thehinge joint (e.g., a connector) during surgery.

Each plate member may have any suitable structure. The plate member mayor may not be elongate. The plate member may have an outer surface(interchangeably termed an outer side or top side) opposite an innersurface (interchangeably termed an inner side or bottom side). The platemembers collectively may form an outer surface (interchangeably termed atop surface) and an inner surface (interchangeably termed a bottomsurface) of the bone plate. The inner surface and the outer surface ofthe bone plate (and each plate member) respectively face toward and awayfrom a bone when the bone plate is attached to the bone. The innersurface may be configured to contact bone. Each plate member may be onepiece, with no parts that move relative to one another withoutdeformation of the plate member. The one-piece plate member may beformed integrally, such that the entire plate member is continuous(monolithic). The plate member has a length, a width, and a thickness,where the thickness is less than the length and width, such as less than50%, 20%, or 10% of the length and/or width. The length is generallygreater than the width, but in some embodiments the length and width maybe equal.

Each plate member may define at least one opening 92 having any suitablestructure and position. Each opening 92 may be a through-hole(interchangeably termed an aperture) that extends through the platemember from the outer surface to the inner surface thereof. Thethrough-hole may have a closed perimeter (completely boundedcircumferentially) or an open perimeter. The through-hole or otheropening may define an axis that is substantially perpendicular oroblique to the plane of the plate member. Each through-hole or otheropening may or may not be elongated in the plane of the plate member.Accordingly, the through-hole may or may not be circular. Thethrough-hole or other opening may or may not have attachment structureformed by a wall thereof that allows a fastener, such as an externallythreaded fastener, to be attached to the plate member at thethrough-hole. The attachment structure may, for example, be an internalthread or at least one linear lip.

The plate member may have any suitable number of openings 92. If theplate member has two or more openings, the openings may be distributedin a direction along and/or across the bone plate from one another.

Each movable joint 82 may have any suitable structure. The joint may beformed at a region of overlap of a pair of the plate members, where theplate members overlap one another and respective joint surfaces of theplate members face and contact one another. The joint surfaces may be atleast generally complementary to one another, with one joint surfacebeing concave and the other joint surface convex. In some embodiments,one or more both joint surfaces may include surface features thatimprove the stability of the locked joint by resisting slippage of thejoint surfaces relative to one another. The surface features may includeone or more protrusions and/or one more voids, each of which may or maynot be deformable. In some embodiments, the surface features may includea uniform array of projections and/or recesses, such as a set of teethdefined by one or both joint surfaces. In some embodiments, the surfacefeatures of one joint surface may be complementary to one or more of thesurface features of the other joint surface, such that the jointsurfaces can be mated with one another to resist slippage. In someembodiments, the joint surfaces can be mated in a plurality of discreteregisters that are offset from one another by the spacing of the surfacefeatures of at least one of the joint surfaces. For example, one of thejoint surfaces may define a plurality of teeth and the other jointsurface may form at least one tooth. The teeth of the one joint surfacecan mate with the at least one tooth of the other joint surface in aplurality of different and discrete registers. Each of the teeth may besymmetrical or asymmetrical in cross section. If symmetrical, the teethmay permit movement of the joint surfaces relative to one another inboth opposite rotational or translational displacement directions of thejoint. If asymmetrical, the teeth of the joint surfaces may collectivelyform a ratchet that selectively permits movement of the joint surfacesin only one of two opposite rotational or displacement directions of thejoint. In some embodiments, the joint surfaces may define surfacefeatures that are not complementary to each other, and the surfacefeatures may deform, particularly when the joint is compressed.

One of both joint surfaces of a joint may be formed at least partiallyby a one-piece body of one of the plate members. The body also maydefine one or more through-holes to receive fasteners. In someembodiments, a joint surface may be formed by the body of one of theplate members and at least one deformable element 98 (also called ananti-slip element) associated with the body. The deformable element maybe softer than the body of both plate members and may be deformedselectively by contact with the other joint surface. For example, thedeformable element may be formed of polymer and each body of metal, orthe deformable element may be formed of a softer metal and each body ofa harder metal, among others. In any event, the deformable element maydeform when the joint is compressed, to resist slippage of the platemembers relative to one another. Surface features of at least one of thejoint surfaces may facilitate deformation of the deformable element. Forexample, one or more of the surface features (e.g., one or more ridges)may form or deepen one or more indentations in the deformable elementwhen the joint is compressed. The deformable element may be disposed atleast partially in a recess formed in one of the joint surfaces and mayproject out of the recess toward the other joint surface, for contacttherewith. The deformable element may be an insert that is formedseparately and then attached to one of the plate member bodies, or thedeformable element may be formed in contact with one of the bodies, suchas by overmolding or otherwise applying a material to the body to createthe deformable element. The deformable element alternatively may beconsidered to be distinct from the plate member. Accordingly, thedeformable element may be firmly attached to one of the plate members ofa joint and movable with respect to the other plate member of the joint.

Bone plate 80 may include a discrete connector 100 that connects theplate members to one another at the joint. The connector may bedescribed as a locking member (which may, in some embodiments, bedescribed as a fastener and/or a lock screw) that controls whether joint82 is in a movable configuration or a fixed (locked) configuration. Theterms “movable” and “fixed” are relative terms. A fixed configurationrequires substantially more force to produce movement of plate membersrelative to one another, such as at least about 5, 10, 25, 50, or 100times as much force, among others. In the fixed configuration, the boneplate may become rigid at the joint, with the plate members rigidlycoupled to one another, so that the bone plate can function like atraditional (non-jointed) bone plate. The connector may extend from oneplate member to another plate member through the joint surfaces of theplate members. For example, the connector may define a pivot axis of thejoint (i.e., may be coaxial to the pivot axis) or may be offset from thepivot axis. Each plate member may define an aperture to receive aportion of the connector. In some embodiments, the connector may have anexternal thread for attaching the connector to one of the plate membersat an aperture thereof. The connector may be rotatable to adjust acompression of the plate members at the joint, thereby determiningwhether the joint is fixed or movable. In some indications, the jointmay not lockable, for example, where the deforming forces act in adifferent plane than the adjustment capability, such as for claviclefixation. Movement at the locked joint may be restricted by any suitablemechanism including any combination of friction, obstruction,interfitment, or the like.

II. Bone Plates with Single-Axis Joints

This section describes exemplary bone plates with hinge joints thatpermit in-plane angular adjustment of plate members relative to oneanother; see FIGS. 2-14B (and also see Examples 1 and 3 of Section VII).

FIGS. 2-6 show an exemplary bone plate 120 having a pair of hinge joints122 a, 122 b arranged along the long axis of the bone plate andpermanently connecting plate members 124, 126, and 128 to one another.(Plate member 126 is a central plate member, and plate members 124 and128 are end plate members.) Each hinge joint resists out-of-planebending and torsional forces, while permitting movement, indicated at130 in FIG. 2, about a single pivot axis arranged transverse (e.g.,orthogonal) to a plane defined by the bone plate and/or at least oneplate member of the hinge joint. This pivotal movement permitsadjustment of the longitudinal shape of the bone plate by in-planemotion of the plate members, to allow a surgeon to customize the boneplate to the longitudinal shape of a subject's bone. In someembodiments, bone plate 120 may have only two plate members connected bya single hinge joint (or four or more plate members connected by threeor more joints). Bone plate 120 may be used to fix a clavicle or anyother suitable bone, such as a femur, tibia, fibula, radius, ulna,humerus, rib, or the like (also see Section VI).

Bone plate 120 may be marked with one or more surface markings 132, todefine a longitudinal region of the bone plate that should overlie thefractured or cut portion of the bone to be fixed (the “fracture zone”)(see FIGS. 2 and 3). The surface marking may be formed by etching,machining, molding, coating, electrolyzing, etc., the bone plate at theregion to be marked, to make the region or boundaries thereof visiblydistinguishable. In some embodiments, the marked region may have adifferent color than other parts of the bone plate. In any event,central plate member 126 may be positioned on a bone to longitudinallyspan the fractured or cut portion of the bone. However, in someembodiments, bone plate 120 can be positioned on a fractured bone with afracture of the bone overlapping end plate member 124 or 128, one of thehinge joints 122 a or 122 b, and/or a region of central plate member 126outside the marked region of the bone plate.

In the depicted embodiment, each hinge joint lacks the ability to beadjustably compressed along the pivot axis, to change the hinge jointbetween movable and fixed configurations. Instead, rotational movementat each joint may be restricted by securing the bone plate to anunbroken (continuous) portion of bone with a pair of fasteners placedinto the unbroken portion on opposite sides of each hinge joint, suchthat the unbroken portion extends from one of the fasteners to the otherfastener of the pair. In some embodiments, the hinge joint may belocated between a pair of through-holes 134 a, 134 b having attachmentstructure for the fasteners (such as an internal thread), to rigidlyattach each fastener to the bone plate. In any event, bone plate 120 maypermit at least two or three fasteners to be placed into unbroken boneon each side of the fracture zone.

The hinge joint may be formed as a movable, half lap joint; see FIGS.3-6. Central plate member 126 may form a tab 136 of reduced thickness ateach of its ends. An axle 138 (interchangeably termed a protrusion or apost) may project orthogonally from the tab. Each end plate member 124,128 may define an undercut region 140 at one of its ends. The end platemember may define an aperture 142 sized to receive the axle (e.g., sizedslightly larger in diameter than the axle), while undercut region 140may be sized to receive tab 136 without increasing the thickness of thebone plate. The end of axle 138 may be deformed (e.g., swaged) (seepanels A and B of FIG. 6) to form a retainer or head 144 that capturesone of the end plate members on the axle, to prevent the plate membersfrom being disconnected from one another without damaging the boneplate. Retainer 144 may occupy a widened region 145 of aperture 142. Insome embodiments, the height of each of tab 136, aperture 142 excludingwidened region 145, and widened region 145 may be about one-third of theoverall height (thickness) of the bone plate at the hinge joint.Retainer 144 may protrude from the top surface of a plate member, orretainer 144 may be flush or recessed with respect to the top surface.In some examples, retainer 144 may be welded to the axle. In someexamples, the entire bone plate (including the hinge joint) may beproduced by 3D printing, optionally followed by deformation at the hingejoint (e.g., at the retainer) to increase the frictional resistance torotation of the plate members. In some examples, retainer 144 may beformed by a discrete element, such as a nut attached to a threadedversion of the axle, among others. In some examples, aspects of thehinge joint may be reversed. For example, central plate member 126 mayform an undercut region that overlies a tab formed by an end platemember at the hinge joint, and/or an end plate member may provide theaxle.

The axle may have any suitable properties. The axle may or may not beelongated along the pivot axis. The axle may be cylindrical or at leastmay have a cylindrical portion disposed in the aperture of the otherplate member. The axle may have a through-hole that is pre-formed beforethe axle is placed into the aperture, or the through-hole may be formedafter the retainer is created, among others. In some embodiments, thethrough-hole may be pre-formed and then modified after the retainer hasbeen created. Modification of the through-hole may include creating aninternal thread in the through-hole, and/or revising the through-hole toremove distortion, if any, produced when the retainer is created.

Each hinge joint 122 a, 122 b may have a frictional resistance that isnot adjustable at the joint by the user (e.g., a surgeon). In otherwords, the hinge joints are not configured to be adjustable off bonebetween a movable configuration and a fixed configuration, as describedin more detail below in Example 3 of Section VII. The frictionalresistance may be set during manufacture of the bone plate by tightlyengaging retainer 144 with one of the plate members, such as a wallregion of aperture 142 and/or an outer surface of the plate member. Abone plate having a hinge joint that lacks distinct movable and fixedconfigurations (and, optionally, has no discrete connector) can make thebone plate easier and faster to install, less likely to experience amechanical malfunction or failure (e.g., caused by a discrete connectorbecoming loose over time), and more resistant to accidental disassembly.

The range of motion at each hinge joint may be determined by contactbetween stop regions 146 and 148 (see FIGS. 2 and 5) and/or stop regions150 and 152 (see FIG. 4), which may be formed by vertical walls ofcentral plate member 126 and an end plate member 124 or 128. The hingejoint may have any suitable range of angular motion, such as at leastabout 5 or 10 degrees, and/or less than about 45, 30, or 20 degrees,among others.

FIGS. 7 and 8 show a bone plate 160 that is a version of bone plate 120having a hinge joint 122 b that can be locked off bone. Overlappedregions of central plate member 126 and end plate member 128 may definea pair of aligned apertures 162, 164 to receive a fastener thatfunctions as a locking member 166. The locking member may be a setscrew. Upper aperture 162 may be elongated transverse to the long axisof the bone plate (and elongated in the plane of the bone plate), toform a slot. Lower aperture 164 may have an internal thread 168. Lockingmember 166 may have an external thread 170 to attach the locking memberto plate member 126 at lower aperture 164. A head 172 of the lockingmember may be disposed in a wider, top region of upper aperture 162 andmoves along the long axis of upper aperture 162 as the plate members ofthe bone plate are pivoted relative to one another at hinge joint 122 b.The underside of head 172 may be tightened against a wall region 174 ofupper aperture 162, to urge plate member 128 into tight engagement withplate member 126, to fix the angular orientation of the plate membersrelative to each other at a selected rotational position. Locking member166 may define a central through-hole 176 to receive a fastener, such asa bone screw 178, that extends into bone.

FIG. 9 shows bone plate 160 locked with a different locking member 182that is not cannulated and is configured to extend below the bone plateinto bone. In other embodiments, non-cannulated locking member 182 maynot extend substantially below the inner surface of the bone plate.

FIGS. 10 and 11 show an exemplary bone plate 200 having a hinge joint202 locked with a connector 204. Plate members 206, 208 of the boneplate are fitted together via a pair of arcuate, complementary matingregions 210, 212 centered around and bracketing pivot axis 214 of hingejoint 202.

Each complementary region 210, 212 includes a mating feature. Forexample the complementary region may include a track 216 defined as anarcuate channel, and an end region, such as a flange 218, that fits intoand is complementary to the track (see FIG. 11). Each track 216 may havean undercut region 220 that retains the flange in the track and resistsseparating movement of plate members 206, 208 from one another inopposite directions parallel to pivot axis 214. More generally, thecomplementary mating features prevent translational disassembly of themated plate members. However, each flange 218 can slide in-plane in thetrack as plate members 206, 208 are pivoted relative to one anotherabout pivot axis 214. The plate members can be mated with one anotherinitially by placing each flange 218 in its corresponding track, withthe plate members arranged obliquely to one another (e.g., at an angleof at least about 20, 40, or 60 degrees from coaxial to one another,among others). The plate members then may be rotationally mated with oneanother by pivoting the plate members toward coaxial alignment with oneanother. The plate members will remain connected to one another in thismated configuration unless they are pivoted far enough out of alignmentto remove each flange from its corresponding track. In some embodiments,the hinge joint may have only one flange and one track formed on onlyone side of pivot axis 214. In some embodiments, one of the platemembers at the hinge joint may form flanges on opposite sides of thepivot axis, and the other plate member may define both tracks forreceiving both flanges.

Plate members 206, 208 may define a pair of aligned apertures 222, 224to receive connector 204. The connector may attach to lower aperture 224by threaded engagement, to ensure that the plate members cannot beinadvertently disconnected from one another. The connector also mayfunction as a lag screw, with a head that can be tightened against theupper plate member near the hinge joint to create tight engagement ofthe plate members with one another to lock the hinge joint at a selectedposition. Connector 204 optionally may include a threaded leading region226 configured to project below the bone plate and into underlying bone.

FIGS. 12 and 13 show a bone plate 230 having a hinge joint 232 that islockable with a connector 234. The bone plate includes a pair of platemembers 236, 238 that overlap at the hinge joint. Lower plate member 236may define a tab from which an axle 240 projects, as described above(e.g., see FIGS. 2-6). The axle may be received in an upper aperture 242of the hinge joint and may be swaged and machined to form an expandablehead or collet 244. The collet may define notches 246 that allowsections of the collet to expand radially, indicated by arrows at 248.Connector 234 may be threaded into lower plate member 236, and a taperedhead 250 of the connector may be advanced into collet 244 of axle 240,which expands collet 244 to produce a friction lock due to engagement ofthe expanded collet with a tapered wall region 252 of aperture 242.

FIGS. 14A and 14B show an exemplary bone plate 260 for fixation of thedistal radius. Bone plate has a head portion 262 for mounting to thedistal end of the radius on a volar side thereof, and a shaft portion264 extending from the head portion. Shaft portion 264, also termed astem portion, may be mounted to the shaft of a radial bone proximal tothe head portion, such that the shaft portion extends at least generallyparallel to the long axis of the radial bone.

Shaft portion 264 may be formed by at least two segments connected by ahinge joint 266 that permits in-plane adjustment of the bone plate. Adistal segment of the shaft portion may be formed by a distal platemember 268 that also forms head portion 262. A proximal plate member 270may form a proximal segment of the shaft. The distal and proximalsegments of the shaft portion may have any suitable relative lengths,such as approximately equal lengths or different lengths (e.g., with thedistal segment longer or shorter than the proximal segment). In someembodiments, the bone plate may be supplied by a kit having two or moreproximal plate members of different length, each interchangeablyattachable to the distal plate member via the hinge joint. The surgeonalso may have the option of installing the distal plate member withoutproximal plate member 270.

Hinge joint 266 may include an end region of one of the plate membersnested in an end region of the other plate member. For example, in thedepicted embodiment, proximal plate member 270 defines a receiving space272 that has received an end region 274 of distal plate member 268. Theproximal plate member may trap the end region of the distal plate memberin the receiving space. For example, the receiving space may be definedin part by a pair of lips 276 of plate member 270 that preventseparation of the plate members from one another in a direction parallelto the pivot axis of the hinge joint. The distance between the lips alsomay decrease toward the entry end of the receiving space to preventseparation of the plate members from one another in a direction parallelto the long axis of shaft portion 264. For example, the lips may bedeformed generally toward one another at a transversely indented region278 of end region 274 of plate member 268, after the plate members havebeen mated with one another, to prevent axial separation of the platemembers, whether or not a connector 279 is installed. Connector 279(e.g., a lock screw) may extend between aligned apertures of platemember 268, 270, and may be adjustable to lock the hinge joint, to fixthe orientation of the plate members relative to one another. Theconnector is coaxial with the pivot axis of the hinge joint. In someembodiments, the head portion and the shaft portion of the bone platealso may be connected to one another by a movable joint, such as amulti-axis joint (e.g., see Section III and Example 4 of Section VII).

III. Bone Plates with Multi-Axis Joints

This section describes exemplary bone plates with multi-axis joints thatpermit adjustment of the angular orientation of a pair of plate membersrelative to one another in each of two or more planes that arenonparallel to one another; see FIGS. 15A-15E and 16-36. Further aspectof bone plates with multi-axis joints are described elsewhere herein,such as in Section VII (e.g., in Example 4).

Bone plates having a multi-axis joint are known. However, the multi-axisjoint relies on friction to prevent movement of joint surfaces when thejoint is locked. When the joint is loaded after installation of the boneplate, slippage of the joint surfaces relative to one another may occur.Multi-axis joints more resistant to slippage are needed.

The multi-axis joints disclosed in this section and in Example 4 ofSection VII, among others, are configured to lock the joint morereliably, such that the joint can withstand a greater load withoutslippage. The joint may utilize material deformation and/or interfitmentof complementary mating features to prevent slippage.

FIGS. 15A-15E each show a joint region of a bone plate 280 having adeformable multi-axis joint. Each embodiment of bone plate 280 has apair of plate members 281, 282 that are connected to one another with adiscrete connector (e.g., a lock screw). The connector can bemanipulated to change the joint from a movable configuration (on theleft) to a fixed configuration (on the right), and vice versa. In themovable configuration, the orientation of plate members 281, 282relative to one another can be adjusted, indicated by a curved motionarrow 283, in each of two or more nonparallel planes. In the fixedconfiguration, the multi-axis joint is locked and the orientation of theplate members cannot be adjusted. The fixed configuration may begenerated by compressive force applied to the plate members via theconnector, which urges joint surfaces 283 a, 283 b of the plate memberstoward one another at the joint, indicated by a pair of motion arrows at284 (see FIG. 15A).

Joint surfaces 283 a, 283 b overlap and face one another. As describedfurther below, one or both joint surfaces may have one or more surfacefeatures (i.e., one or more protrusions or voids) that encouragedeformation of one or both joint surfaces when the joint is placed inthe fixed configuration. Also, or alternatively, one or both jointsurfaces may be formed non-integrally, which allows a material property,such as the hardness, of at least one of the joint surfaces to varyacross the joint surface.

Compressive force may be directed to an interface 285 at which jointsurfaces 283 a, 283 b contact one another in the movable configurationbefore the joint is locked (see FIG. 15A). The interface may be only afraction of the area of the joint surfaces (e.g., less than 50, 25, or10% of the area), to increase the force per unit area at the interfaceand promote deformation at the interface. One or both of the platemembers may be deformed at the interface. This deformation causes theplate members to locally obstruct movement 283 relative to one another,which can lock the joint much more effectively and stably than friction.The shear strength of the plate members where they obstruct one anotherbecomes important in preventing movement at the joint.

Joint surfaces 283 a, 283 b may include respective joint surface regions286, 287 that are complementary to one another. The surface regions eachmay be spherical, with the same radius of curvature, and may form anysuitable continuous or non-continuous portion of a complete sphere.Overlying surface region 286 may be convex, as shown, or concave.Underlying surface region 287 may be concave, as shown, or convex.Furthermore, the relative positions (underlying/overlying) of the platemembers may be switched.

Joint surface 283 a forms at least one protrusion 288 configured todeform and/or be deformed by joint surface 283 b when the joint isplaced in the fixed configuration. Deformation may be plastic, elastic,or a combination thereof. Each protrusion 288 is raised (elevated) withrespect to surface region 286, as shown, and may project from thesurface region. The one or more protrusions may be discrete from surfaceregion 286 (see FIGS. 15A-15C) or integral with the surface region (seeFIGS. 15D and 15E). Accordingly, a body 289 of the plate member thatforms surface region 286 (and defines one or more through-holes toreceive fasteners) may be discrete or unitary with protrusion 288. Eachprotrusion projects beyond surface region 286 toward plate member 282and joint surface 283 b. The protrusion may, for example, project from aposition within or outside the perimeter of surface region 286.Exemplary protrusions include ridges, studs, or the like.

Protrusions 288 may constitute less than one-half of the area of jointsurface 283 a. For example, the protrusions may constitute less than 25%or 10% of the area, to concentrate compressive force at the protrusions.

Joint surface 283 b may define one or more voids 290 that are recessedwith respect to surface region 287. Each void may extend into platemember 282 from surface region 287 any suitable distance and may or maynot be elongated along or transverse to the surface region. The voidsare configured to receive at least a portion of each protrusion 288 whenthe joint is placed in the fixed configuration. The protrusion may bedisposed in and/or extend into at least one of the voids after (FIGS.15A, 15D, and 15E), or both before and after (FIG. 15B), the joint isplaced in the fixed configuration. In any event, at least a portion ofeach protrusion enters a space created by at least one void (with orwithout void deformation), and the protrusion extends into or extendsmore deeply into the at least one void when the joint is placed in thefixed configuration. Voids and surface region 287 may be formedintegrally with one another (FIGS. 15A, 15D, and 15E) or may be formedat least in part with a discrete element (FIG. 15B). In someembodiments, the one or more voids may isolate areas 291 of surfaceregion 287 from one another (see FIG. 15A). For example, joint surface283 a may define intersecting surface channels that surround and isolateareas 291 from one another. In other embodiments, surface region 287 maybe continuous.

Voids may have a depth (d) with any suitable relationship to a height(h) of each protrusion 288. For example, the depth may be at least 10,25, 50, or 100% of the height. Exemplary depths (d) of the voids and/orheights (h) of the protrusion(s) include at least 0.1, 0.2, 0.5, or 1millimeter, among others. In some embodiments, the depth may be greaterthan the height, to encourage “bottoming out” in which surface region286 engages surface region 287 (see FIGS. 15D and 15E). Engagement ofsurface regions 286, 287 with one another may enhance the stability ofthe locked joint.

One or both of the plate members may include at least one deformableelement 292 that is discrete from body 289 of the plate member. Thedeformable element(s) may be created in a spaced relationship to body289 and then associated with the body, or the deformable element(s) maybe created on the body, such as by addition of material to the body(e.g., by overmolding, spraying, etc.). The deformable element(s) may bemore deformable (plastically and/or elastically) than either body 289,either surface region 286 or 287, the other plate member, or anycombination thereof, among others. Each deformable element may be formedof a different material than body 289 (e.g., a softer material), may bemore porous, or the like. The deformable element may be disposed in arecess 293 defined by body 289 and may project from the recess to formprotrusion 288 (see FIG. 15A). The deformable element may be attached tothe body, whether or not the deformable element is disposed in a recess.Attachment may be achieved by press-fitting, bonding, an adhesive,creating the deformable element on the body, or the like. In someembodiments, the deformable element may form a protrusion 294 of jointsurface 283 b (of plate member 282) that can contact and be deformed bya protrusion 288 of joint surface 283 a (of plate member 281) (see FIG.15C).

FIG. 15A shows deformable element 292 being deformed by joint surface283 b of plate member 282, such that the deformable member extends intoplate member 282 beyond surface region 287. In the depicted embodiment,voids 290 are not deformed substantially when the joint is placed in thefixed configuration. In some embodiments, the voids may be larger (e.g.,wider), such that the entire protrusion can be received in a single voidand surface regions 286, 287 can engage one another.

FIG. 15B shows protrusion 288 extending beyond surface region 287 ofplate member 282 into a void 290 defined collectively by body 289 anddeformable element 292. The protrusion can slide along a surface of thedeformable element in the movable configuration of the joint, andextends into the deformable element in the fixed configuration of thejoint. The protrusion extends beyond surface region 287 into platemember 282 in both the movable and fixed configurations, but extendsfarther in the fixed configuration.

FIG. 15C shows protrusion 288 of plate member 281 in slidable contactwith deformable protrusion 294 of plate member 282. Protrusion 288extends into the deformable element 292 when the joint is placed in thefixed configuration. A depression 295 formed at the base of protrusion288 receives a portion of deformable element 292.

FIGS. 15D and 15E show bone plates 280 that do not have a discretedeformable element 292. Protrusion 288 is formed integrally with surfaceregion 286, and voids 290 are formed integrally with surface region 287.In FIG. 15D, the plate members have about the same hardness.Accordingly, protrusion 288 and at least one void 290 are deformed. InFIG. 15E, plate member 282 is softer than plate member 281. Plate member282 is deformed predominantly. In other embodiments having integrallyformed joint surfaces, plate member 281 (and particularly eachprotrusion 288) is deformed predominantly.

FIGS. 16-21 show an exemplary bone plate 300 for fixation of the distalradius. Bone plate 300 has a multi-axis joint 302 movably connecting ahead plate member 304 to a shaft plate member 306 of the bone plate. Themulti-axis joint of the depicted embodiment (and in other embodimentsdisclosed herein for the distal radius) permits continuousdorsal-ventral adjustability and continuous radial-ulnar adjustabilityof the head plate member relative to the shaft plate member. Head platemember 304 includes a pair of deformable elements 308 (anti-slipelements) that form protrusions of the joint surface of the plate member(also see FIG. 15A). Shaft plate member 306 has a joint surface definingvoids 310 in the form of channels that receive a portion of eachdeformable element as the joint is compressed and locked by a connector312 (which may be a lock screw).

The joint surfaces of plate members 304, 306 include respectivecomplementary joint surface regions 314, 316 (such as spherical surfaceregions with the same radius of curvature) that face one another in aregion of overlap 317 of bone plate 300. Head surface region 314 may beconcave, and shaft surface region 316 may be convex (or vice versa).Also, the head surface region may be above or below the shaft surfaceregion.

The multi-axis joint may permit adjustment of the orientation of theplate members relative to one another in two or more nonparallel planes.The orientation may be adjusted in-plane about a central axis 318 ofconnector 312. (In other words, the orientation may be adjusted in aplane orthogonal to central axis 318.) The connector is received in (andaxis 318 extends through) a pair of aligned apertures 320, 322 (alsocalled openings) defined by the respective plate members. FIG. 18illustrates in phantom an adjusted position for shaft plate member 306after in-plane motion. The orientation also may be adjusted about eachof a pair of axes 324, 326 that are transverse (e.g., substantiallyorthogonal) to one another and to central axis 318 (see FIG. 16). (Inother words, the orientation may be adjusted in a pair of planes thatare respectively orthogonal to axes 324 and 326.) Axes 324 and 326 maybe spaced from and disposed below the inner (bottom) surface of the boneplate, as shown. Alternatively, axes 324 and 326 may be spaced from anddisposed above the outer (top) surface of the bone plate (see below) ormay intersect the bone plate, among others.

The range of motion permitted by joint 302 may be determined by anysuitable combination of contact between (a) a head 328 of connector 312and a side wall 330 of a recessed region 332 formed by upper aperture320 (e.g., see FIGS. 16, 19, and 20), (b) a shaft 334 of connector 312and a lower side wall region 336 of elongated upper aperture 320 (e.g.,see FIGS. 16 and 19), and (c) a perimeter wall region 338 of shaft platemember 306 and a side wall region 340 near joint surface region 314(e.g., see FIGS. 16 and 18). In exemplary embodiments, the joint permitsan range of adjustment of the volar tilt of the head plate memberrelative to the shaft plate member (about axis 324) of about 10-20degrees, among others, and a range of adjustment of the radial-ulnartilt about axis 318 of about 6-10 degrees, among others.

Deformable elements 308 may be disposed in recesses 342, such asfurrows, which may defined within the perimeter of upper joint surfaceregion 314 (see FIGS. 18, 20, and 21). Each deformable element may beattached to plate member 304 in one of recesses 342. Each recess 342 andthe deformable element 308 disposed therein may be elongated transverseto voids 310, such that voids 310 and deformable elements 308 areoriented crosswise relative to one another. Each deformable element 308may protrude from its corresponding recess 342, to form a protrusion 344that is raised relative to surface region 314 (see FIGS. 20 and 21). Inother words, the protrusion extends beyond surface region 314 toward theother surface region 316. When connector 312 is tightened to compressthe joint, each deformable element 308 may be deformed such that aportion of the deformable element (and a portion of protrusion 344)enters at least one void 310.

Deformable element 308 may leverage the shear strength of a materialjammed between two metal surfaces for a continuous (non-discrete)adjustment of the plate members relative to one another at the joint.This approach may be more effective than the use of a friction lock,which may be more susceptible to slippage, or the use of potentiallyless user-friendly inter-fitted teeth, which generally require one ofthe plate members (and particularly its joint surface) to move up anddown at the joint as the register of complementary sets of teeth ischanged. Each deformable element 308 may, for example, be formed ofmetal or any suitable polymer, such as polyether ether ketone (PEEK) ora carbon-fiber PEEK composite, among others. The amount of deformationof the deformable element may help to determine the holding strength ofthe joint.

FIGS. 22-26 and 26A show another exemplary bone plate 360 for fixationof the distal radius. Bone plate 360 may be constructed generally asdescribed above for bone plates 280 and 300 (see FIGS. 15A and 16-21)and may have any suitable combination of features described for boneplates 280 and 300 and any other bone plates of the present disclosure.

Bone plate 360 has a multi-axis joint 362 formed at a region of overlapof a head plate member 364 and a shaft plate member 366. Plate members364 and 366 respectively form surface regions 367, 368 of the jointarranged on a sphere 369 having a center 370 below the bone plate (seeFIG. 26). Shaft plate member 366 may overlie head plate member 364 atthe joint, rather than underlying the head plate member as in bone plate300 (compare FIGS. 22 and 26 with FIGS. 16 and 19).

Multi-axis joint 362 may be locked (placed in a fixed configuration) bya connector 372 (e.g., a lock screw) having a head 374 disposed under,rather than over, joint surface regions 367, 368 of the plate members(see FIG. 26). However, the end of a shaft 376 of the connector, insteadof the connector's head, may define a driver interface 378 (e.g., ahexagonal socket, among others). Accordingly, the joint may be lockedand released from the outer side of bone plate 360 after the bone platehas been placed onto and/or attached to bone.

Connector 372 may have a thread that is reverse-handed relative to thethreads of other fasteners used to secure the bone plate to bone, tomake manipulation of the connector more intuitive for the surgeon. Forexample, if the bone plate is secured to bone with bone screws havingright-handed threads, the connector may have a left-handed thread, suchthat the surgeon turns the bone screws and the connector in the samedirection (clockwise (from above)) to tighten the bone screws againstthe bone plate and to lock the joint.

The range of motion permitted by multi-axis joint 362 may be determinedby a stop region formed cooperatively by a raised member or projection380 (also called a boss) of shaft plate member 366, and an aperture 382defined by head plate member 364 (see FIGS. 24-26). Aperture 382receives projection 380 and connector 372. The aperture may be definedcentral to the joint surface and/or joint surface region 367 of themember. Contact between the perimeter wall of projection 380 and theperimeter wall of aperture 382 may establish a range of motion of theplate members relative to one another in each plane of adjustmentpermitted by the joint. The use of a projection 380 positioned insidebone plate 360 to determine the range of motion of joint 362 isadvantageous because the range of motion can be defined withoutaffecting the external geometry of the bone plate. Accordingly, theexternal shape of the bone plate can be designed for optimal performanceand subject compatibility with the joint in the fixed configuration.

Aperture 382 and an aligned aperture 384 defined by shaft plate member366 receive portions of shaft 376 of connector 372 (see FIG. 26).Aperture 384 is internally threaded for attachment to shaft 376 via theshaft's external (left-handed) thread. Aperture 384 extends throughprojection 380, and projection 380 may be centered on aperture 384.

Aperture 382 may have two or more distinct regions arranged between theinner surface and the outer surface of head plate member 364 (see FIGS.25 and 26). The aperture has a minimum-width region 386 that is narrowerthan the diameter of the connector's head 374, to prevent the head frompassing through aperture 382. Aperture 382 also has a wider regionbetween minimum-width region 386 and the outer surface of head platemember 364, to form a receiver 388 for projection 380. Aperture 382 alsomay widen as it extends from minimum-width region 386 to the innersurface of the head plate member, to form a space 389 for receiving head374 of the connector.

Deformable elements 308 may be arranged to be deformed by contact withthe opposite joint surface when the joint is compressed, as describedabove for bone plate plates 280 and 300 (see FIGS. 24, 25, and 26A, andalso see FIGS. 15A, 16, and 20).

FIGS. 27 and 27A show yet another exemplary bone plate 390 for distalradius fixation. Bone plate 390 is similar to bone plate 360 except thatthe joint surfaces are curved upward (away from bone) rather thandownward (toward bone), to position a center of rotation 392 aboverather than below the bone plate (compare FIG. 26 with FIG. 27, and FIG.26A with FIG. 27A). Structures for establishing the range of motion ineach plane are labeled with the same reference numbers as for bone plate360.

FIG. 28 shows another exemplary bone plate 410 for fixation of thedistal radius. (Fastener-receiving through-holes of each plate memberhave been omitted to simplify the presentation.) Bone plate 410 has ahead plate member 412 connected to a shaft plate member 414 by amulti-axis joint 416. An inverted lock screw 418 and a triangular nut420 are attached to one another by threaded engagement to hold the jointtogether. Nut 420 may be received in a triangular aperture 422 that isdefined by one of the plate members and that is oversized with respectto the nut. The difference in size between the nut and the aperturedetermines the range of motion of the plate members in each plane. Theorientation of the plate members can be adjusted in a given plane untilcontact between a wall of the nut and a perimeter of the aperture blocksfurther movement in that plane. In other embodiments, the nut may beformed integrally by one of the plate members.

FIG. 29 shows still another exemplary bone plate 440 for fixation of thedistal radius. Bone plate 440 has a head plate member 442 and a shaftplate member 444 connected to each other at a multi-axis joint 446. Aconnector that extends through an upper aperture 448 defined by headplate member 442 and that threads into an internally-threaded loweraperture 450 defined by shaft plate member 444 is omitted to simplifythe presentation. Head plate member 442 and shaft plate member 444 mayhave joint surfaces forming respective, complementary, convex andconcave joint surface regions 452, 454 that face one another at thejoint. The connector applies compression to the joint and urges thejoint surfaces against one another to deform at least one of the jointsurfaces and lock the joint at a selected position. The joint surfacesmay be structured as described above for bone plate 280 of FIGS. 15D and15E.

The joint surfaces may define one or more surface features thatfacilitate deformation of one or both of the plate members at the joint.In some embodiments, the surface features may be created by removingmaterial from (or adding material to) a featureless precursor surface,which may create a pattern.

FIG. 30 shows the joint surface of plate member 444, which is composedof joint surface region 454 and a void 456 that is recessed with respectto joint surface region 454. The void may be formed by removal ofmaterial from a continuous, spherical precursor surface, to create agrid of channels that are recessed with respect to spherical surfaceregion 454. The grid of channels creates discontinuities in theprecursor surface such that joint surface region 454 is discontinuousand composed of separate surface areas.

FIGS. 31 and 32 show other examples of a joint surface for shaft platemember 444. The joint surface may be composed of joint surface region454 and voids 456 structured as concentric grooves (FIG. 31) or parallelgrooves (FIG. 32), which may be formed in a spherical precursor surface.In yet other examples, the grooves may, for example, be arrangedradially, or may cross one another.

The voids and/or surface region 454 may be manufactured by any suitableprocess, such as milling, electrical discharge machining, sinteringbeads or other particles, photo-etching, 3D printing, etc. The processcreates voids that a deformable material at the joint can enter as thejoint is compressed to place the joint in a fixed configuration.

FIGS. 33-35 show exemplary structure for one or more protrusions 462that are raised with respect to joint surface region 452 of head platemember 442, for contact with any of the joint surfaces and/or jointsurface regions 454 of FIGS. 30-32. Each protrusion may be formedintegrally with joint surface region 452. Alternatively, the protrusionmay be formed separately (e.g., as a deformable element; see FIG. 15A)and then attached to the plate member near surface region 452 (e.g.,within the perimeter of the surface region and/or with the protrusionprojecting from the surface region). FIG. 33 shows a deformable ringprotrusion 462. The ring protrusion may protrude from a groove 464defined by a body 466 of head plate member 442 or may be formedintegrally with the body. FIG. 34 shows a plurality of discreteprotrusions 462 formed as bosses arranged around aperture 448 defined bybody 466 of plate member 442. The bosses may protrude to a raisedposition from respective recesses 472 defined by body 466 or may beformed integrally with the body. FIG. 35 shows a plurality ofprotrusions 462 structured as parallel ridges.

FIG. 36 shows still another exemplary bone plate 490 for fixation of thedistal radius. Bone plate 490 has a multi-axis joint 492 that may bestructured and locked as described above for bone plate 440. However,bone plate 490 differs from bone plate 440 by having a head portion 494formed collectively by a pair of plate members 496, 498 connected to oneanother at joint 492. Main plate member 496 may form a shaft portion 500and an ulnar section 502 (or a radial section 504) of head portion 494.Branch plate member 498 articulates with main plate member 496 at aposition along the main plate member that is intermediate shaft portion500 and ulnar section 502. The branch plate member forms radial section504 (or an ulnar section) of head portion 494. Ulnar section 502 andradial section 504 have a side-by-side arrangement in which the sectionsare arranged along a line from one another, with the line beingtransverse to a long axis of the bone plate.

Bone plates having joints permitting multi-axis adjustment have beenillustrated for use on the distal radius, such as on a volar sidethereof. However, in other embodiments, any of the bone plates may beshaped and sized for use on any other suitable bone, such as any longbone. Also, the bone plates may be configured to have a head portion forplacement closer to an end of the long bone, and a shaft portion forplacement farther from the end of the long bone, although in someembodiments, the bone plates may not have a head portion.

IV. Bone Plates with Single-Axis Joints for Out-of-Plane AngularAdjustment

This section describes exemplary bone plates with joints that permitout-of-plane angular adjustment of plate members relative to oneanother, optionally in only one plane; see FIGS. 37-43.

The bone plates of this section may be used to fix any suitable bone. Inexemplary embodiments, the bone plates may fix a tibia (e.g.,proximally), a femur (e.g., distally), or a humerus (e.g., proximally),among others. The bone plates may, for example, provide a varus/valgusadjustment near the end of a bone. The adjustment permitted by each boneplate may be discrete or continuous.

FIGS. 37-39 show an exemplary bone plate 520 having a generallycylindrical joint 522 at which a head plate member 524 is connected to ashaft plate member 526 with an inverted lock screw 528. Joint 522permits movement of plate members 524 and 526 relative to one anotherabout a rotation axis that is below the bone plate and at leastgenerally parallel to a plane defined by the bone plate and/or a platemember thereof (and optionally at least generally parallel to a widthaxis of the bone plate). Stated differently, joint 522 permits movementof the plate members relative to one another in a plane that is at leastgenerally parallel to the long axis of the bone plate and transverse(e.g., orthogonal) to a plane defined by the bone plate or at least oneof the plate members thereof.

Head plate member 524 may define a receiving space 530, at an end regionof the plate member and on an inner side thereof, to receive an endregion of shaft plate member 526 (see FIG. 39). Each of the end regionsmay define complementary joint surfaces 532, 534 that are each generallycylindrical. The joint surfaces may define surface features, such ascomplementary sets of teeth 536, 538 that fit together in a plurality ofdifferent registers. Each register represents a different, discreteangular adjustment of the plate members relative to one another aboutthe rotation axis of the joint. Transverse motion of the plate membersrelative to one another at the joint, when the joint is in a movableconfiguration, may be restricted by a pair of flanges 540, 542 of thehead plate member that bracket the end region of the shaft plate member(or vice versa) (see FIGS. 37 and 39).

FIGS. 40-42 show another bone plate 560 have a generally cylindricaljoint 562. Bone plate 560 is similar to bone plate 520 except that joint562 is curved in an opposite direction from joint 522 of bone plate 520.Elements and features of bone plate 560 corresponding to those of boneplate 520 are labeled with the same reference numbers used for boneplate 520.

FIG. 43 shows a bone plate 580 having a generally cylindrical joint 582at which a head plate member 584 is connected to a shaft plate member586 by a threaded connector (not shown). The plate members may beconstructed generally as described above for bone plates 520 and 560(see FIGS. 37-42). However, joint 582 may be continuously adjustable,rather than discretely adjustable. The joint may rely on deformation ofat least one of the joint surfaces, to prevent slippage of the lockedjoint, and may have any of the features described above in Section IIIfor multi-axis joints. Accordingly, the teeth present in the joints ofbone plates 520 and 560 may be replaced by one or more deformableelements (anti-slip elements), which may protrude into voids 590 definedby the joint surface of plate member 584, when the joint is locked.

V. Bone Plates with Joints to Adjust Translational Offset

This section describes an exemplary bone plate 610 having a joint 612that permits plate members to be displaced relative to one another in aplane 614 without substantially changing their orientations relative toone another; see FIG. 44.

Bone plate 610 may have a pair of plate members, such as a head platemember 616 connected to a shaft plate member 618. Joint 612 may includecomplementary teeth that allow discrete adjustment of the plate membersat the joint. Bone plate 610 may have any of the features of other boneplates of the present disclosure and may be most similar to bone plate560 (see FIGS. 40-42), but modified to have a generally planar jointrather than a generally cylindrical joint.

VI. Methods of Bone Fixation

This section describes exemplary methods of fixing bone using any of thebone plates disclosed herein. The steps presented in the section may beperformed in any suitable order and combination, and may be modified byor combined with any of the other procedures and features disclosedelsewhere herein.

At least one bone to be fixed may be selected. The bone(s) may be anysuitable bone(s) of a vertebrate species, such as an arm bone (e.g., ahumerus, ulna, or radius), a leg bone (e.g., a femur, tibia, or fibula),a hand/wrist bone (e.g., a carpal, metacarpal, or phalange), afoot/ankle bone (e.g., a tarsal, metatarsal, calcaneus, or phalange), arib, a sternum, a scapula, a clavicle, a pelvis, a cranial bone, afacial bone, a vertebra, or the like, or any combination thereof ofadjacent bones. The bone may have any suitable discontinuity orstructural weakness, such as at least one fracture, at least one cut, anonunion, or the like, or two or more adjacent bones may be selected tobe fused to one another.

An incision may be created through overlying soft tissue to access theselected at least one bone. The selected bone may be manipulated toreposition bone fragments (e.g., to approximate the relative anatomicallocation of the fragments), such as to set a fracture. Manipulation ofbone fragments (or two or more selected bones) may be performed beforeor after the incision is created.

A bone plate may be selected for stabilizing the selected bone. The boneplate may have at least two plate members connected by at least onemovable joint as disclosed herein.

The bone plate may be placed through the incision and onto the selectedbone. The incision may be at least about a long as or shorter than thebone plate.

The bone plate may be attached to the bone with fasteners, such as bonescrews, placed into one or more through-holes of each plate member andextending into the bone.

The rotational and/or translational position of the plate membersrelative to one another may be adjusted before and/or after the boneplate is attached to the bone. Adjustment may be performed with a jointof the bone plate in a movable configuration that permits movement ofthe plate members relative to one another. The bone plate may be placedin a fixed configuration after the adjustment, to fix the positions ofthe plate members relative to one another. The incision then may beclosed.

Bone plates with single-axis or multi-axis joints may be adjusted atdifferent times during a bone fixation procedure. The longitudinal shapeof a hinged bone plate having one or more hinge joints may be adjustedfully before the bone plate is attached to the bone, or at least beforeeach plate member is attached to the bone. In some cases, theorientation of first and second plate members connected by a hinge jointmay be adjusted after attaching the first plate member to bone andbefore attaching the second plate member to bone. The second platemember may be rotated relative to the first plate member, to a desiredorientation, and then the second plate member may be attached to thebone. If the hinged bone plate has three or more plate members, thisprocess may be performed again for each additional plate member beforethe plate member is attached to the bone. In other words, the platemembers of the hinged bone plate may be successively aligned with thebone and then attached. The orientation of plate members of a bone platehaving a multi-axis joint may be adjusted after the plate members areattached to different pieces of bone, to change the orientation of thepieces of bone (e.g., to improve fracture reduction).

VII. Examples

The following examples describe selected aspects and embodiments of thepresent disclosure related to bone plates with movable joints. Theseexamples are included for illustration and are not intended to limit ordefine the entire scope of the present disclosure.

Example 1. Exemplary Bone Plate with a Hinge Joint Having a DeformableElement

This example describes an exemplary bone plate 630 that includes a hingejoint 632 having a deformable element 634 to facilitate locking thejoint; see FIGS. 45-47.

Bone plate 630 may have a head plate member 636 connected to a shaftplate member 638 by a lock screw 640. Hinge joint 632 may be adjustableabout a pivot axis 642 that is coaxial with lock screw 640.

Deformable element 634 may positioned to be compressed by adjustment oflock screw 640. The deformable element may be disposed in a recess 644defined by shaft plate member 638. A washer 646 may be located between ahead 648 of the lock screw and a top side of deformable element 634. Thewasher may have radial teeth 650 that contact the top side of thedeformable element. As the lock screw is tightened, the teeth may biteinto the deformable element to fix the angular position of the platemembers.

Further aspects of hinge joints and deformable elements are describedelsewhere in the present disclosure, such as in Sections II and III andin Examples 3 and 4, among others.

Example 2. Exemplary Bone Plates with a Longitudinal Rotation Axis

This example describes exemplary bone plates including a generallycylindrical joint that permits angular adjustment of plate membersrelative to one another about an axis that is at least generallyparallel to the long axis of the bone plate; see FIGS. 48-53.

FIGS. 48-52 show an exemplary bone plate 660 having a generallycylindrical joint 662 with a rotation axis 663 arranged at leastgenerally parallel to a long axis defined by the bone plate (e.g.,within about 20, 10, or 5 degrees of parallel, among others). Bone plate660 has a head plate member 664 connected to a shaft plate member 666 bya connector 668 that determines whether the joint is in a movable or afixed configuration. Joint 662 permits the orientation of the platemembers to be adjustable continuously in a plane transverse to the longaxis of the bone plate.

FIG. 49 is an end view of bone plate 660 illustrating phantom movementof head plate member 664 relative to shaft plate member 666. The headplate member is movable in either rotational direction, indicated byarrows at 672.

FIGS. 51 and 52 show further aspects of joint 662. At least onedeformable element 674 may be located in a recess defined by head platemember 664, to form part of the joint surface of the head plate member.The deformable element projects from the recess toward the joint surfaceof shaft plate member 666. The deformable element is deformed as thejoint is locked by turning connector 668, and enters voids 676 definedby the joint surface of shaft plate member 666 (see FIG. 52). Deformableelement 674, the recess, and/or voids 676 may be arranged in a planeparallel to the plane in which the plate members rotate. Bone plate 660may have any combination of the features described elsewhere herein,such as above in Section III and below in Example 4, among others.

FIG. 53 shows another exemplary bone plate 690 having a generallycylindrical joint 692. Bone plate 690 may be structured the same as boneplate 660 of FIGS. 48-52, except that joint 692 is discretely adjustablethrough the mating of complementary surface features (teeth in thedepicted embodiment) that fit together in a plurality of differentregisters, each producing a discrete angular change in the orientationof the plate members relative to one another.

Example 3. Exemplary Hinge Joints and Associated Plate Structure

This example describes exemplary bone plates each including one or morehinge joints connecting two or more plate members; see FIGS. 54-71. Thefeatures of the bone plates and hinge joints described in this examplemay be combined with one another and/or with any of the elements andfeatures described elsewhere in the present disclosure, such as inSections I and II, and in other examples of this section, among others.

FIGS. 54-56 show an exemplary bone plate 700 having a closed(non-cannulated) hinge joint 702 and an open (cannulated) hinge joint704 connecting three plate members 706, 708, and 710 to one anotherend-to-end. In FIG. 54, bone plate 700 is positioned on a clavicle 712having at least one fracture 714, before attachment of the bone plate tothe clavicle with fasteners (such as bone screws) extending into theclavicle from circular and oblong through-holes 716 of the bone plate.The through-holes may have different sizes, such as smaller holes (e.g.,in most-lateral plate member 706) to receive wires or pins, and largerthrough-holes to receive bone screws. One of the through-holes iscoaxial to the pivot axis of open hinge joint 704. (Closed hinge joint702 cannot receive a fastener extending into bone.) Each of platemembers 706 and 710 is rotatable in-plane with respect to central platemember 708, indicated by rotation arrows 718 in FIG. 54, to customizethe longitudinal shape of the bone plate to follow the clavicle (orother elongated bone).

Clavicle 712 is shown with the acromial extremity (the lateral end) onthe left and the sternal facet (the medial end) on the right. The boneplate can be positioned at any suitable location along the clavicle,such as near the lateral end of the clavicle in the depicted embodiment.

FIGS. 55 and 56 show respective bottom and sectional views of bone plate700. One or both end plate members 706 and 710 may have a selectivelydeformable region 720 created at least in part by a recess 722 formed ina bottom surface of the plate member. The recess may taper as it extendstoward a transverse midpoint of the plate member from opposite edgesthereof, to form a central notch 724. The recess may be formed at anarrowed region 726 of the plate member created by aligned indentationsdefined by opposite edges of the plate member. Deformable region 720provides a site at which the plate member can be selectively deformedout-of-plane (bent and/or twisted), such that the plate member moreclosely follows the contour of an underlying bone.

FIGS. 57-59 show an exemplary bone plate 730 having a pair of open hingejoints 732 connecting three plate members 734, 736, and 738 to oneanother end-to-end. In FIG. 57, the bone plate is positioned morecentrally along clavicle 712 than bone plate 700 of FIG. 54. Rotationalmotion of plate members 734 and 738 with respect to central plate member736 is shown in phantom indicated with motion arrows at 718.

Bone plate 730 is similar to bone plate 120 of FIGS. 2-6 and may haveany combination of features described above for bone plate 120 (seeSection II), among others. For example, the resistance to pivotal motionof each hinge joint 732 may be configured not to be user-adjustable atthe hinge joint, such as not adjustable between configurations that aremovable and fixed off bone (or one bone). Instead, each hinge joint 732may have an intrinsic resistance (e.g., frictional resistance) topivotal motion that is configured not to vary substantially as the boneplate is manipulated and installed.

Hinge joint 732 is formed by an axle 740 of plate member 736 captured inan aperture 742 of plate member 738. Axle 740 is formed integrally witha body 744 of plate member 736, where the body defines one or morethrough-holes 746 outside a region of overlap 748 of the plate memberswith one another (see FIGS. 57-59). A retainer 750 (also called aretaining portion) for axle 740 is larger in diameter than the minimumdiameter of aperture 742, which prevents removal of the axle from theaperture, and permanently connects the plate members to one another. Theretainer may be formed integrally with the axle, fused to the axle bywelding, created by 3D printing both plate members together in aconnected configuration, or the like.

Friction between axle 742 and plate member 738 prevents the platemembers from rotating freely relative to one another. Plate members thatcannot rotate freely relative to one another require application offorce greater than the torque generated by gravity to generate rotation.The torque generated by gravity is determined with the pivot axis andthe long axis of the bone plate both horizontal, and with the platemember of smaller mass held stationary.

Frictional resistance to rotation may, for example, be created bytightly engaging axle 740 with a wall of aperture 742. For example,wider retainer 750 may be tightly engaged with the wall of an end region752 of aperture 742, such as by swaging, during manufacture of the boneplate. End region 752 may have a diameter (e.g., a minimum or averagediameter) that is greater than the minimum diameter of aperture 742.Here, end region 752 is tapered, such as conically tapered, but may becylindrical, among others. In other embodiments, a cylindrical region754 of axle 740 may engage a wall region 756 of aperture 742 to providea majority of the frictional resistance to rotation.

The resistance (e.g., frictional resistance) to rotation at each hingejoint may be set during manufacture of the bone plate, such as whenretainer 750 is created. In some embodiments, the resistance may bedetermined by deformation of the axle. The resistance may require atorque of at least about 1, 2, or 5 inch-pounds, or at least about 1, 2,5, or 10 foot-pounds, among others, to rotate the plate members relativeto one another. In some embodiments, the resistance may be set such thatone or more tools are advantageous and/or required to provide amechanical advantage to rotate the plate members (see below), while thebone plate is off and/or on bone. In other words, the plate members maynot be rotatable by hand without the use of at least one tool.

Hinge joint 732 is an open joint defining a through-hole 758 extendingalong a pivot axis 760 defined by axle 740. Through-hole 758 may (or maynot) have an internal thread 762 to attach a fastener, such as a bonescrew, to the wall of the through-hole. In other examples, a fastenermay be placed into bone from through-hole 758 without attachment to thewall of the through-hole. The through-hole may have a wider region, suchas a counterbore 764, formed at the entry end to receive a head of thefastener. The presence of a through-hole arranged on the pivot axis ofthe joint offers various advantages. For example, the bone plate can beattached to bone more securely. Also, the spacing of through-holes (andthus installed fasteners) along the bone plate can be more uniform.

FIG. 59 shows respective concave and convex walls 766, 768 of joint 732that determine an angular range of motion for the plate members throughcontact with one another that blocks further rotation. Each wall has acircular region 770 and a pair of linear regions 772 extendingtangentially from opposite ends of the circular region. The circularregions may have the same radius of curvature. However, the circularregion of convex wall 768 formed by plate member 738 is longer than thecircular region of concave wall 766 formed by plate member 736. Theplate members can be rotated in either rotational direction until thelinear wall regions on one end of the circular regions are abutted withone another. A tapered gap 774 is formed between the linear regions ononly one or both ends of the circular regions when the plate members arerespectively intermediate or at the two stopped positions at theopposite extremes of the rotational range of rotation. In the depictedembodiment, plate member 738 has been rotated counterclockwise (and/orplate member 736 clockwise) to a stopped position at which the linearwall regions on one end of the circular regions are abutted, indicatedby an arrow at 776. Each plate member may have any suitable range ofmotion, such as at least about 5, 10, 15, or 20 degrees, and/or lessthan about 60, 40, or 30 degrees, among others.

FIG. 60 shows a bone plate 780 having a closed hinge joint 782. Hingejoint 782 is similar to open hinge joint 732 of bone plate 730 (see FIG.58), except for the absence of through-hole 758 and a protruding shapefor retainer 750.

FIG. 61 shows an exemplary bone plate 790 having a pair of closed hingejoints 792 connecting three plate members 794, 796, and 798 end-to-end.Each hinge joint includes a connector 800 that connects a pair of theplate members to one another in a region of overlap where the platemembers overlap one another.

FIG. 62 shows a sectional view of bone plate 790 taken through one ofthe hinge joints. Connector 800 is a threaded member (a screw) having aninverted configuration, with a head 802 below a shaft 804, when the boneplate is oriented with an inner, bone-contacting surface 806 of the boneplate facing down (as in FIG. 62).

In other words, head 802 is closer to inner surface 806 and shaft 804 iscloser to an outer surface 808 of the bone plate.

The connector is received in a pair of aligned apertures 810, 812 ofplate members 796, 798. Shaft 804 has an external thread 814 thatattaches to an internal thread in aperture 810 of plate member 796. Headis received in a wider region (a counterbore) of aperture 812 and abutsa shoulder 816 defined by the aperture.

Connector 800 has a driver interface, such as an opening 818, for matingwith a complementary working end of a driver. The opening extends intothe shaft from an end thereof. Opening 818 is accessible from above thebone plate and allows the driver to turn the connector, to adjust thejoint between movable and fixed configurations. Since connector 800 isinverted, external thread 814 may be left-handed to provide theconventional directions of rotation for tightening and loosening athreaded member. In other words, from the perspective of a surgeon abovethe bone plate, rotating the connector clockwise compresses the platemembers from a movable configuration of the joint to produce a fixedconfiguration, and rotating the connector counterclockwise from a fixedconfiguration of the joint reduces compression of the plate members toproduce a movable configuration of the joint. In other embodiments,opening 818 may be replaced by an external driver interface, such asfacets, among others.

Plate member 798 is created with a flange 820 projecting (e.g.,orthogonally) from an inner surface of the plate member, in a directionaway from the outer surface of the plate member. The flange initiallydoes not extend into aperture 812 and/or obstruct placement of connector800 into aligned apertures 810, 812. However, after the hinge joint hasbeen assembled, flange 820 can be deformed by rolling the flangeradially inward, indicated in phantom at 822, to a configuration thatobstructs travel of the connector's head 802 out of aperture 812 alongpivot axis 760. With the flange preventing removal of connector 800,plate members 796 and 798 are permanently connected to one another,because connector 800 cannot be removed from hinge joint 792 (withoutdamaging bone plate 790). The flange also may provide a stop that limitshow much the connector (and thus the hinge joint) can be loosened. Thestop thus helps the surgeon to avoid placing the joint in a freelymovable configuration in which the bone plate becomes excessivelyflexible. Any of the bone plates disclosed herein, including bone plateswith multi-axis joints, may include a flange 822 near or at an outersurface or an inner surface of a plate member, to obstruct removal of aconnector from the bone plate, such that plate members are permanentlyconnected to one another.

Plate members 796 and 798 overlap one another in a half-lapconfiguration. Accordingly, in the depicted embodiment, the platemembers do not mate with one another through mating features (e.g., anend region or flange of one plate member received in a track formed bythe other plate member). Connector 800 prevents this translationalseparation. In other embodiments, as described below, the plate membersmay include complementary mating features that facilitate (a) mating theplate members with one another, (b) aligning a pair of apertures of theplate members, (c) retaining the plate members adjacent one anotherbefore a connector is installed, and/or (d) increasing a bendingstrength of the bone plate at the joint.

Hinge joint 792, or any other hinge joint disclosed herein, may belocated between a pair of circular through-holes 824 and adjacent eachof the through-holes (see FIGS. 61 and 62). One or both of thethrough-holes 824 may have an internal thread 826. In some embodiments,one or both through-holes 824 may be replaced by a slot 828, which maybe elongated parallel to the long axis of a plate member that definesthe slot (see FIG. 61).

FIGS. 63-65 show an exemplary bone plate 830 having a pair of hingejoints 832 connecting three plate members 834, 836, 838 end-to-end. Boneplate 830 is similar to bone plate 790 and may have any combination offeatures described for bone plate 790, except that each hinge joint 832is open rather than closed. Also, the plate members have undercut matingfeatures, as described below.

Hinge joint 832 is considered open because the joint includes aconnector 840 defining a through-hole 842 to receive a fastener, such asa threaded fastener (e.g., a bone screw or peg) placed along a pivotaxis 760 defined by the connector. Through-hole 842 defines a driverinterface that is complementary to the working end of a suitable driver,to allow turning the connector with the driver. In the depictedembodiment, through-hole 842 defines a plurality of axial channels 846(parallel to pivot axis 760) to receive corresponding axial ridges of adriver. Through-hole 842 has an internal thread 848 for threadedengagement with a fastener, and a counterbore 850 to receive a head ofthe fastener. Internal thread 848 may be right-handed, and an externalthread 852 of connector 840 may be left-handed. Axial channels 846extend transversely to the internal thread and remove portions thereof.In other embodiments, the through-hole may lack an internal thread.

Connector 840 is prevented from removal by a deformed flange 822 ofplate member 834, as described above for bone plate 790 (see FIG. 62).Accordingly, a pair of plate members are permanently connected to oneanother at each hinge joint.

FIG. 64 shows complementary mating features 854 formed by plate members834, 836 at a region of overlap. These mating features can increase thebending strength of the bone plate at the joint, relative to a half-lapconfiguration (see FIG. 62), by spreading out the stress distribution.The mating features may have a partial-dovetail configuration. (SeeFIGS. 10 and 11 for another configuration.) Each mating feature may beundercut with respect to an inner surface and an outer surface of one ofthe plate members. More particularly, plate member 834 defines a track856 (e.g., an arcuate channel) that receives an end region 858 of platemember 836. Track 856 is undercut with respect to the inner and outersurfaces of plate member 834, and end region 858 is undercut withrespect to the inner and outer surfaces of plate member 836. Also, platemember 836 defines a track 860 (e.g., an arcuate channel) that receivesan end region 862 of plate member 834. Track and end region 860, 862 areundercut with respect to the inner and outer surfaces of plate members836 and 834, respectively. Each track and end region may be arcuate in aplane orthogonal to the pivot axis, with track 856 and end region 858having a curvature that is opposite to the curvature of track 860 andend region 862. A line of curvature defined by each track and each endregion may be concave with respect to pivot axis 760, and may have acenter of curvature on the pivot axis.

FIGS. 66 and 67 show another exemplary bone plate 870 having a hingejoint 872 formed by a pair of plate members 874, 876 and a connector878. (Connector 878 is present only in FIG. 67.) The bone plate may haveany suitable combination of the features of the present disclosure.

Plate members 874, 876 are permanently connected to one another with apin 880, whether or not connector 878 is installed. Pin 880 is attachedto one of the plate members (e.g., rigidly coupled to plate member 874)and extends into an arcuate slot 882 defined by the other plate member(e.g., plate member 876). The pin travels along the slot as the platemembers are pivoted relative to another about pivot axis 760, and isstopped by opposite ends of the slot, to define a range of rotation forthe plate members about the pivot axis. The pin may extend into the boneplate from a position near the inner surface (or the outer surface) ofthe bone plate.

Pin 880 has a head 886 and a shaft 888. The pin may be attached to platemember 874 via head 886, and shaft 888 may extend into slot 882. In someembodiments, the pin may be press-fitted into an opening 890 defined byplate member 874 to attach the pin to the plate member.

The plate members may have various mating features. The mating featuresmay include complementary rotational mating features 854 formed by platemembers 874 and 876 at hinge joint 872, as described above for boneplate 830 (see FIG. 64). The mating features also or alternatively mayinclude complementary mating features 892 that cooperate with pin 880 topermanently connect the plate members to one another. Mating features892 include a protrusion, such as a boss 894, received in acomplementary recess 896. The boss and recess both may be coaxial topivot axis 760.

The plate members may be assembled with one another as follows. Theplate members may be translationally mated with one another along pivotaxis 760 by placing boss 894 into recess 896. Translational mating maybe performed with plate members 874 and 876 at an angle to one anotherat which complementary mating features 854 are not yet mated with oneanother. In other words, mating features 854 are not yet overlappingbecause they are rotationally offset from one another. The angle may,for example, be at least 30 or 45 degrees from coaxial alignment of theplate members with one another.

The plate members then may be rotationally mated with one another byrotating the plate members relative to one another about pivot axis 760toward coaxial alignment, such that complementary mating features 854are mated with one another. Mating features 854 are considered matedwhen least a portion of each male region is received in eachcorresponding track (also see the description above for bone plate 830(FIG. 64)).

The plate members may be rotationally adjusted, while remaining mated,such that opening 890 is aligned with slot 882. Pin 880 then may beplaced into opening 890, to attach the pin to plate member 874, with theshaft of the pin extending into slot 882 of plate member 876. The platemembers now are permanently connected to one another and are pivotableabout pivot axis 760 through a range of rotation determined by the pinin the slot. This arrangement is advantageous because a discreteconnector (besides the pin) is not required to keep the plate membersconnected, and because the range of motion can be determined inside thebone plate without affecting the external geometry of the bone plate.

Connector 878 may be installed in aligned apertures 898, 900 defined bythe plate members at any suitable time. The connector may be placedthrough aperture 898 and into threaded engagement with aperture 900before or after pin 880 is installed. Connector 878 can be manipulatedto adjust hinge joint 872 between movable and fixed configurations, asdescribed elsewhere herein. In some embodiments, bone plate 870 may besupplied to a user (e.g., a surgeon) with connector 878 alreadyinstalled, and, optionally, with hinge joint 872 in a fixedconfiguration (e.g., with the plate members coaxially aligned with oneanother). The orientation of the plate members relative to one anothermay be adjusted via the hinge joint (in a movable configuration), andthe plate members may be attached to bone with fasteners. Connector 878may be replaced with a corresponding fastener 902 that has a longershaft than the connector and is configured to extend into bone after thebone plate has been placed on and/or attached to the bone. Fastener 902is disposed in threaded engagement with plate member 874 and isadjustable to place the hinge joint in a fixed configuration, with thefastener extending into bone. In other embodiments, connector 878 may becannulated to define a through-hole with or without an internal thread.In these embodiments, a fastener may be placed into bone from thethrough-hole along pivot axis 760, while connector 878 remains attachedto plate member 874.

FIGS. 68-70 show an exemplary bone plate 910 having an open hinge joint912. The hinge joint is created by a pair of plate members 914, 916 anda snap-fit connector 918 that permanently connects the plate members toone another. Plate members 914, 916 have complementary mating features854, as described above, and define a pair of aligned apertures 920, 922to receive connector 918.

Connector 918 has a head 924 and a shaft 926. Shaft 926 defines aplurality of notches 928 (also called slots) that divide a leading endregion of the shaft into a plurality of axial sections 930 (also calledtabs). One or more of sections 930 have locking features 932 to createlocking tabs that prevent removal of the connector after it has beensnap-fitted into aligned apertures 920, 922. The locking features mayproject radially outward and engage a shoulder 934 defined by aperture920, while head 924 engages a shoulder 936 defined by aperture 922, toprevent travel in either direction along pivot axis 760. Sections 930are sufficiently flexible to bend radially inward as connector 918 isbeing placed into apertures 920, 922, and sufficiently elastic to moveradially outward again after shoulder 934 has been cleared.

Connector 918 may define a through-hole 938, which may have an internalthread 940. The connector may be unable to rotate with respect to platemember 914 about pivot axis 760, which facilitates placement of a lockscrew into threaded engagement with through-hole 938. Rotation ofconnector 918 may be prevented by a non-circular region (e.g., a flat942) of the connector and a corresponding non-circular region ofaperture 922 (see FIGS. 69 and 70). The lock screw may have a taperedhead that urges sections 930 radially outward as the screw is advancedinto through-hole 938, to place the joint in a fixed configuration.

FIG. 71 shows bone plate 730 of FIG. 57 engaged by a pair of tools 950a, 950 b positioned on opposite sides of one of hinge joints 732. Tools950 a, 950 b are being used to apply torque to rotate plate members 734,736 relative to one another, indicated by arrows 952, to adjust anorientation of the plate members. The tools provide a mechanicaladvantage over manipulation of the plate members directly by hand, andallow application of a greater torque than with the hands alone. Thetools, which may be called instruments, may or may not be copies of oneanother.

In other embodiments, tools 950 a, 950 b may be replaced by a singletool to apply the torque. For example, tools 950 a, 950 b may be hingedto one another to create a single tool.

Each tool may engage a suitable portion of the bone plate. In thedepicted embodiment, each tool is engaging opposite edges of the boneplate when torque is applied. In other embodiments, the toolalternatively or additionally may engage one or more openings (e.g.,through-holes) of the bone plate.

Each tool may provide a lever arm of any suitable length for applicationof torque to the bone plate. In some embodiments, the lever arm may belonger than one or both plate members that are being rotated relative toone another.

The tool may be configured to engage the bone plate when the bone plateis off bone, as shown here. Alternatively, the tool may be configured toengage the bone plate whether the bone plate is off bone or attached tobone.

Example 4. Exemplary Multi-Axis Joints and Associated Plate Structure

This example describes exemplary bone plates each including a movablejoint connecting a pair of plate members, with the joint being amulti-axis joint having at least two nonparallel planes ofadjustability; see FIGS. 72-86. The features of the bone plates andmulti-axis joints described in this example may be combined with oneanother and/or with any of the elements and features described elsewherein the present disclosure, such as in Sections I and III, and in otherExamples of this section, among others.

FIGS. 72-76 show an exemplary bone plate 960 for fixation of the distalradius. The bone plate has a multi-axis joint 962 connecting a headplate member 964 to a shaft plate member 966. A connector 968 (e.g., ascrew) is disposed in a pair of aligned apertures 970, 972 defined bythe plate members. The connector is adjustable to change the jointbetween movable and fixed configurations. The connector may have aninverted configuration, with the head of the connector below the shaft,when the inner (bottom) surface of the bone plate is facing down. Ashaft of the connector may define a driver interface to receive theworking end of a suitable driver. For example, the shaft may define asocket 974 extending into the shaft from an end of the shaft oppositethe head of the connector. Accordingly, the connector may have anexternal thread that is left-handed.

Plate members 964, 966 have respective head and shaft surface regions976, 978 that are complementary to and face one another in a region ofoverlap 980 of the bone plate. Each of the surface regions may bespherical (i.e., defining and/or corresponding to a sphere or a portionthereof). The surface regions may or may not contact one another in thefixed configuration of the joint.

Each plate member 964, 966 also may have a joint surface with one ormore protrusions 982 (see FIGS. 73, 74, and 76) and/or defining one ormore voids 984 (see FIGS. 74 and 76). Each protrusion is elevated, andeach void is depressed, with respect to an associated surface region 976or 978. In the depicted embodiment, protrusions 982 project from and areraised with respect to surface region 978 of shaft plate member 966.Also, voids 984 are recessed with respect to surface region 976 of headplate member 964. Each protrusion and void may function to preventmovement of the plate members relative to one another when joint 962 isin a fixed configuration, as described further below. The protrusion orvoid may be disposed within the perimeter of the surface region of theplate member and/or near (e.g., adjacent) the perimeter, among others.

Shaft plate member 966 has a body 986 and a pair of deformable elements988 attached to the body in region of overlap 980 (see FIG. 76). Body986 forms the majority of shaft plate member 966, for example,determining at least one, two, or each of the three characteristicdimensions (length, width, and thickness) of the shaft plate member.Body 986 also defines through-holes 990 outside region of overlap 980,to receive fasteners, and may define aperture 970 (see FIGS. 72 and 74).Furthermore, body 986 may define at least one recess 992 to receivedeformable elements 988 (see FIG. 76). Recess 992 may have a depth thatis less than the height of deformable element 988, such that thedeformable element projects from the recess to form protrusion 982.Deformable element 988 may be attached to body 986 at recess 992.

Voids 984 may be formed integrally with joint surface region 976 of thejoint surface by a body 994 of head plate member 964. Each body 986 and994 may be harder than deformable element 988. Accordingly, deformationof the deformable element (and protrusion 982) may be predominant overdeformation of surface region 976 and/or voids 984 when the joint isplaced in the fixed configuration.

Bone plate 960 also may include a projection 996 of plate member 966received in aperture 972 to define a range of motion of the platemembers at joint 962 (see FIGS. 73 and 74). Projection 996 and aperture972 are similar to projection 380 and aperture 382 of bone plate 360(see FIGS. 24-26).

FIG. 75 shows bone plate 960 with head plate member 964 in threedifferent volar orientations permitted by movement of the head platemember relative to shaft plane member 966 in a plane 998 that isparallel to the long axis of the shaft plate member and perpendicular toa plane defined by the shaft plate member. The three differentorientations are labeled as neutral (arbitrarily assigned as 0° volar),5° volar, and 10° volar. As the head plate member moves to a more volarinclination, the length of the bone plate increases, indicated by lines1002 and 1004. Movement of deformable elements 988 with respect to voids984 also is shown, with the voids moving distally as head plate memberassumes a more volar tilt.

FIG. 77 shows selected portions of another exemplary bone plate 1020 forfixation of the distal radius. In particular, only a bottom side of theproximal end region of a shaft plate member 1022 of bone plate 1020 isshown. The shaft plate member includes a joint surface region 1024 of amulti-axis joint. The bone may have any of the features described abovefor bone plate 960 (see FIGS. 72-76), such as aperture 970 andprojection 996. However, the position of the deformable elements and thevoids is different than in bone plate 960.

Shaft plate member 1022 provides a joint surface of the multi-axisjoint. The joint surface is composed of surface region 1024 and a pairof protrusions 1026 projecting from the surface region within theperimeter thereof toward a joint surface from by the head plate member.Protrusions 1026 are formed integrally with a body 1028 of shaft platemember 1022, with the body forming surface region 1024. The protrusionsoverlap and contact a pair of underlying deformable elements 1030 (shownin phantom) of the joint surface of the head plate member. Thedeformable elements may be disposed in recesses defined by the body ofthe head plate member. The recesses are recessed with respect to a jointsurface region of the head plate member. Each deformable element 1030may protrude from one of the recesses to form a deformable protrusionthat contacts and is deformed by one of protrusions 1026 (also see FIG.15C). Alternatively, each deformable element 1030 may be flush orrecessed with respect to the joint surface region of the head platemember (also see FIG. 15B). If recessed, the deformable element maydefine a void cooperatively with a portion of the recess in which thedeformable element is located. The void may receive at least a portionof protrusion 1026 before the joint is locked, and may be deformed whenthe joint is placed in a fixed configuration.

FIGS. 78-81 show a bone plate 1040 having a multi-axis joint 1042 with acombination of discrete and continuous adjustability. The bone plate isconfigured, in the depicted embodiment, for fixation of the distalradius, but may be configured or use on any suitable bone. Bone plate1040 has a head plate member 1044 connected to a shaft plate member 1046at joint 1042 with a connector 1048 (e.g., an externally threadedmember, such as a screw). The connector is disposed in a pair of alignedapertures 1050, 1052 and attaches to aperture 1052 via threadedengagement (see FIGS. 79 and 80). The connector allows the joint to beadjusted between movable and fixed configurations. In some embodiments,the connector may have an inverted configuration, with the head of theconnector disposed below the shaft, as described elsewhere herein.

Joint 1042 includes complementary joint surfaces 1054, 1056 that arespherical (see FIGS. 79 and 80). Joint surfaces 1054, 1056 face oneanother and may be in contact in movable and fixed configurations of thejoint. The joint surfaces permit continuous adjustability in each planeof motion of the joint. Apertures 1050, 1052 extend through jointsurfaces 1054 and 1056, respectively.

Joint 1042 also includes a ratchet 1058 positioned adjacent thespherical part of the joint (see FIGS. 78 and 81). The ratchet is formedby a series of teeth 1060 of shaft plate member 1046 and an edge 1062 ofhead plate member 1044 that mates with the teeth (see FIGS. 79-81). Edge1062 is alternatively received in each of a plurality of complementarynotches 1064 (also called recesses) formed between the teeth, todiscretely and incrementally adjust an orientation of the plate membersin a plane orthogonal to a plane 1066 defined by the ratchet. Teeth1060, edge 1062, and notches 1064 each may be arcuate in a planeparallel to plane 1066, and each may follow a portion of a circular paththat is coaxial to aperture 1052. In the depicted embodiment, theratchet provides discrete, incremental dorsal-ventral adjustability, andpermits continuous radial-ulnar adjustability.

The ratchet provides discrete adjustability in each plane of acontinuous set of vertical planes, such as plane 1068 (see FIG. 78),while permitting continuous adjustability in an at least generallyhorizontal plane 1066 (e.g., within 20, 10, or 5 degrees of perfectlyhorizontal) (see FIG. 81). (Vertical and horizontal with respect to boneplate 1040 are defined with the outer surface of the bone plate facingup and the inner surface facing down.) Placement of edge 1062 in eachsuccessive notch 1064 closer to joint surface 1056 creates incrementalrotation of the head plate member relative to the shaft plate member inan at least generally vertical plane (e.g., within 20, 10, or 5 degreesof perfectly vertical) (see FIGS. 79 and 81).

The ratchet may provide any suitable number of discrete orientations ofadjustment for the bone plate, such as at least or exactly 2, 3, 4, 5,or more. In the depicted embodiment, edge 1062 can be receivedalternatively in each of four notches 1064, to incrementally change thevolar tilt of the head plate member. Successive notches may change theangle defined between the respective planes of the plate members by anysuitable amount, such as at least or about 1, 2, 3, 4, or 5 degrees,among others.

The ratchet may selectively permit and restrict discrete adjustment inopposite rotational directions. In the depicted embodiment, the ratchetselectively permits incremental movement of edge 1062 toward jointsurface 1056, while selectively restricting incremental movement of theedge away from joint surface 1056. Teeth 1060 may be asymmetrical toproduce this bias for the direction of adjustment. The preferredrotational direction may increase (or decrease) an angular offsetbetween respective planes defined by the plate members. For example, inthe depicted embodiment, the preferred rotational directionincrementally increases the volar angle of tilt of the head platemember. In other embodiments, the ratchet may be configured to permitunbiased incremental adjustment in both rotational directions.

The range of motion of the plate members relative to one another inplane 1066 may be limited. In the depicted embodiment, a tab 1070 ofhead plate member 1044 is received in a slot 1072 of shaft plate member1046. Contact between the tab and a wall of slot 1072 sets a limit forrotation in plane 1066 in both rotational directions, in each of thediscrete mated configurations of edge 1062 with notches 1064. Slot 1072interrupts teeth 1060 and notches 1064.

Tab 1070 provides an indicator for the orientation of the plate membersin plane 1066. The orientation of tab 1070 with respect to slot 1072corresponds to the orientation of the head plate member relative to theshaft plate member in plane 1066. The tab is visible from above the boneplate, which allows a surgeon to determine the orientation of the headplate member in plane 1066 by viewing the tab. In some embodiments, theshaft plate member may include reference marks arrayed transversely nearthe tab, to allow a surgeon to read the tab orientation more accurately.

Bone plate 1040 may have any suitable features of the other jointsdisclosed herein. For example, one or both joint surfaces 1054, 1056 maybe configured to deform when the joint is placed in a fixedconfiguration. Each joint surface may include one or more protrusionsand/or one or more voids to encourage deformation, as described inSection III (e.g., see FIGS. 15A-15E). At least one of the jointsurfaces may (or may not) be formed, at least in part, by a discretedeformable element. Also, or alternatively, connector 1048 may have anyof the features disclosed elsewhere herein. For example, the connectormay be inverted, with a head under a shaft, and may have a left-handedthread. Also or alternatively, removal of the connector may beobstructed (e.g., by a flange of one of the plate members; see FIG. 62),such that the plate members are permanently connected to one another.

FIGS. 82-86 are a series of views of a bone plate 1080 for fixation ofthe proximal humerus 1082. The bone plate has a head plate member 1084and a shaft plate member 1086 connected to one another by a multi-axisjoint 1088 (see FIG. 82), such as any of the multi-axis joints of thepresent disclosure. The joint is lockable by manipulation of a connector1090 (see FIG. 84). Humerus 1082 has sustained a fracture 1092 (or hasbeen cut transversely), which divides the bone into a proximal piece anda distal piece. Each plate member is secured to one of the pieces withbone screws, although the screws are not shown here to simplify thepresentation. FIGS. 82 and 83 show exemplary varus-valgus adjustment.FIGS. 84-86 show exemplary flexion-extension adjustment.

Example 5. Selected Embodiments I

The following selected embodiments, presented as a series of numberedparagraphs, are intended for illustration and should not limit theentire scope of the present disclosure.

1. A device for fixing bone, comprising: a pair of plate membersconnected to one another via a hinge joint, each plate member definingone or more apertures to receive fasteners that secure each of the pairof plates to bone.

2. The device of paragraph 1, wherein the hinge joint permits in-planeadjustment of the position of the plate members relative to one another.

3. The device of paragraph 1 or paragraph 2, wherein the pair of platemembers define a pair of locking apertures that bracket the hinge joint.

4. The device of any of paragraphs 1 to 3, wherein the hinge jointincludes a protrusion that is integral to one of the pair of platemembers and that is received in a hole of the other of the pair of platemembers.

5. The device of paragraph 4, wherein an end of the protrusion is swagedto prevent its removal from the hole.

6. The device of any of paragraphs 1 to 5, wherein the pair of platemembers are mated with one another such that the plates cannot beseparated from one another, at least when the plates are axially alignedwith one another.

7. The device of paragraph 6, wherein one of the plate members defines acavity, and wherein the other of the plate members has an end receivedin the cavity.

8. The device of paragraph 6 or paragraph 7, wherein the plate membersare mated in a dovetail configuration.

9. The device of any of paragraphs 1 to 8, wherein the pair of platemembers are a first plate member and a second plate member, furthercomprising a third plate member connected to the second plate member viaanother hinge joint.

10. The device of any of paragraphs 1 to 9, wherein one of the platemembers is marked to indicate an axial zone within which each fractureof a bone should be located.

11. The device of any of paragraphs 1 to 10, wherein the pair of platemembers define a pair of aligned apertures, further comprising afastener configured (a) to be received in the pair of aligned apertureson an axis spaced from a pivot axis defined by the hinge joint and (b)to attach to at least one of the apertures of the pair of alignedapertures.

12. A device for fixing bone, comprising: a pair of plate membersconnected to one another at a rotatable joint, each plate memberdefining one or more apertures to receive fasteners that secure each ofthe pair of plate members to bone.

13. The device of paragraph 12, wherein the rotatable joint includes adeformable material disposed between the pair of plate members.

14. The device of paragraph 13, wherein the deformable material includesa polymer.

15. The device of paragraph 14, wherein the polymer includes polyetherether ketone (PEEK).

16. The device of any of paragraphs 12 to 15, wherein each plate memberof the pair of plate members is formed of metal.

17. The device of any of paragraphs 12 to 16, wherein each plate memberprovides a joint surface of the rotatable joint, and wherein at leastone of the joint surfaces defines a plurality of concavities.

18. The device of any of paragraphs 13 to 17, wherein at least one ofthe pair of plate members defines one or more concavities in which atleast a portion of the deformable material is disposed before therotatable joint is locked.

19. The device of any of paragraphs 13 to 18, wherein at least one ofthe pair of plate members defines a plurality of concavities configuredto receive at least a portion of the deformable material when thedeformable material is deformed by compression of the rotatable joint.

20. The device of paragraph 18 or paragraph 19, wherein the concavitiesinclude one or more grooves.

21. The device of any of paragraphs 18 to 20, wherein the one or moreconcavities are formed by a grid.

22. The device of any of paragraphs 18 to 21, wherein at least one ofconcavities is formed by machining, molding, etching, plasma coating,sintered particles, or a combination thereof.

23. The device of any of paragraphs 12 to 22, wherein joint surfaces ofthe pair of plate members contact one another, and wherein at least oneof the joint surfaces is configured to deform when the rotatable jointis locked.

24. The device of any of paragraphs 12 to 23, wherein the rotatablejoint permits the pair of plate members to pivot relative to one anotherin-plane and out-of-plane.

25. The device of any of paragraphs 12 to 24, wherein the rotatablejoint has a center of rotation disposed above a top/outer side of thedevice.

26. The device of any of paragraphs 12 to 24, wherein the rotatablejoint has a center of rotation disposed below a bottom/inner side of thedevice.

27. The device of any of paragraphs 12 to 26, further comprising afastener extending from one plate member to the other plate member ofthe pair of plate members and adjustable to lock the rotatable joint.

28. The device of paragraph 27, wherein the fastener has a head and ashaft.

29. The device of paragraph 28, wherein the shaft extends toward abottom/inner side of the device from the head.

30. The device of paragraph 28 or paragraph 29, wherein the head engagesa collet to lock the rotatable joint.

31. The device of paragraph 30, wherein the collet is formed integrallyby a plate member of the pair of plate members.

32. The device of paragraph 30 or 31, wherein the head is conical or atleast tapers toward the shaft.

33. The device of any of paragraphs 28 and 30 to 32, wherein the shaftextends toward a top/outer side of the device from the head.

34. The device of paragraph 33, wherein a thread is formed on the shaft,and wherein the thread is reverse-handed (e.g., left-handed) relative toa thread formed on each fastener that attaches the bone plate to bone.

35. The device of any of paragraphs 12 to 34, wherein the rotatablejoint has an unlocked configuration that restricts a range of motion ofthe pair of plate members relative to one another.

36. The device of paragraph 35, wherein one of the plate members definesa boss, wherein the other of the plate members defines an opening thatreceives the boss, wherein, optionally, a wall of the boss contacts awall of the opening to restrict the range of motion, and wherein,optionally the range of motion is restricted in at least two nonparallelplanes of rotation of the rotatable joint.

37. The device of paragraph 36, wherein the wall of the opening and/orthe wall of the boss includes a pair of parallel wall regions that atleast generally face one another.

38. A method of bone fixation, the method comprising: (A) selecting thedevice of any of paragraphs 1 to 37; and (B) securing the device to atleast one bone with one or more fasteners, such as bone screws.

39. The method of paragraph 38, wherein the at least one bone is adistal radius, a clavicle, a proximal humerus, or a distal femur, amongothers.

40. The method of paragraph 38 or paragraph 39, further comprising astep of adjusting a position of the pair of plate members relative toone another before and/or after the step of securing, and a step oflocking the joint after the step of adjusting.

41. The method of paragraph 40, wherein the step of adjusting isperformed using one or more tools engaged with at least one of the platemembers.

42. The method of any of paragraphs 38 to 41, further comprising a stepof preventing movement of the plate members relative to one another withat least one fastener that extends into bone.

43. The method of paragraph 42, wherein the step of preventing movementincludes a step of locking a bone screw to each plate member of the pairof plate members on opposite sides of the rotatable joint.

44. The method of any of paragraphs 38 to 41, further comprising a stepof locking the joint with a fastener having a head disposed below jointsurfaces of the plate members that face one another.

45. The method of any of paragraphs 38 to 41, further comprising a stepof deforming a material and/or surface of the joint as the joint isbeing locked.

Example 6. Selected Embodiments II

The following selected embodiments, presented as a series of numberedparagraphs, are intended for illustration and should not limit theentire scope of the present disclosure. The embodiments relate to a boneplate having a hinge joint.

1. A bone plate for fixing bone, comprising: a pair of plate membersoverlapping and connected to one another in a region of overlap by ahinge joint that permits rotation of the plate members relative to oneanother about a pivot axis, each plate member defining one or morethrough-holes outside the region of overlap to receive one or morefasteners to attach the plate member to bone.

2. The bone plate of paragraph 1, further comprising a connector thatconnects the plate members to one another in the region of overlap toform the hinge joint, wherein the hinge joint permits in-plane rotationof the plate members relative to one another about a single pivot axisdefined by the connector.

3. The bone plate of paragraph 2, wherein the hinge joint is adjustablebetween a movable configuration and a fixed configuration bymanipulation of the connector.

4. The bone plate of any of paragraphs 1 to 3, wherein the bone platedefines a through-hole that is coaxial to the pivot axis and configuredto receive a fastener that attaches the hinge joint to bone, wherein,optionally, the through-hole has an internal thread, and wherein,optionally, the through-hole is formed by a connector that connects theplate members to one another.

5. The bone plate of any of paragraphs 1 to 4, wherein contact betweenthe pair of plate members sets a limit for pivotal motion in bothrotational directions about the pivot axis.

6. The bone plate of any of paragraphs 1 to 5, wherein each plate memberhas a range of pivotal motion of no more than 20, 30, 40, or 50 degreesrelative to the other plate member.

7. The bone plate of any of paragraphs 1 to 6, wherein the bone plateincludes a third plate member, and wherein one of the plate members ofthe pair of plate members overlaps and is connected to the third platemember to form a pivotable connection that permits rotation of the oneplate member and the third plate member relative to one another aboutanother pivot axis.

8. The bone plate of paragraph 7, wherein the pivot axes are parallel toone another.

9. The bone plate of paragraph 7, wherein the pivot axes are notparallel to one another.

10. The bone plate of any of paragraphs 1 to 9, wherein the bone plateand/or one of the plate members defines a plane, and wherein each platemember remains in the plane as the plate member rotates about the pivotaxis.

11. The bone plate of any of paragraphs 1 to 10, wherein the bone plateis configured to be attached to a clavicle.

12. A system including the bone plate of any of paragraphs 1 to 11 andfurther comprising a plurality of bone screws to occupy each of the oneor more through-holes defined by each plate member and to occupy anadditional through-hole that is coaxial to the pivot axis.

13. The bone plate of any of paragraphs 1 to 12, wherein the hinge jointcreates a resistance to rotation of the plate members relative to oneanother about the pivot axis, and wherein the resistance is notadjustable off bone.

14. The bone plate of any of paragraphs 1 and 4 to 13, wherein one ofthe plate members includes an axle that extends into an aperture definedby the other plate member, and wherein the axle defines the pivot axis.

15. The bone plate of paragraph 14, further comprising a retainer thatcaptures the axle in the aperture.

16. The bone plate of any of paragraphs 1 to 12, wherein the platemembers are connected to one another by a connector having an externalthread.

17. The bone plate of paragraph 16, wherein the connector has a headunder a shaft.

18. The bone plate of paragraph 16 or paragraph 17, wherein the externalthread is left-handed.

19. The bone plate of paragraph 16, wherein the connector is notremovable.

20. The bone plate of paragraph 19, wherein one of the plate membersobstructs travel of a head of the connector in both directions along thepivot axis.

21. The bone plate of any of paragraphs 1 to 20, wherein one of theplate members defines a slot, wherein the other plate member is attachedto a pin that extends into the slot, and wherein the pin and the slotcooperatively define a range of rotation for the plate members about thepivot axis.

22. The bone plate of any of paragraphs 1 to 21, wherein one of theplate members forms a track, wherein the other plate member has an endregion received in the track.

23. The bone plate of paragraph 22, wherein the track follows an arcuatepath in a plane orthogonal to the pivot axis.

24. The bone plate of paragraph 23, wherein the arcuate path has acenter of curvature on the pivot axis.

25. The bone plate of paragraph 22 or paragraph 23, wherein the endregion and the track slide relative to one another along the arcuatepath when the plate members are rotated about the pivot axis.

26. The bone plate of any of paragraphs 22 to 25, wherein the track is achannel.

27. The bone plate of paragraph 22, wherein the track is a first trackand the end region is first end region, wherein the plate members form asecond track and a second end region received in the track, and whereinthe second track and the second end region are spaced from the firsttrack and the first end region.

28. The bone plate of paragraph 27, wherein the pivot axis extendsthrough the bone plate between the first track and the second track.

29. The bone plate of paragraph 27 or paragraph 28, wherein the otherplate member forms the second track.

30. The bone plate of any of paragraphs 27 to 29, wherein each track andeach end region is arcuate in a plane orthogonal to the pivot axis.

31. Method of making a device for bone fixation, the method comprising,in any order: (A) mating a first plate member with a second platemember, the plate members having complementary features such that themated plate members are able to rotate relative to one another about apivot axis until the plate members are unmated, and prevented from beingseparated, while mated, by movement relative to one another parallel tothe pivot axis; and (B) installing a pin that establishes a range ofrotation for the plate members to prevent rotational unmating of theplate members from one another.

32. A method of fixing bone, the method comprising, in any order: (A)placing a bone plate onto a bone as a unit, the bone plate including apair of plate members overlapping and pre-connected to one another at aregion of overlap to form a pivotable connection that permits rotationof the plate members relative to one another about a pivot axis; (B)attaching each plate member to the bone with one or more fastenersextending into the bone from one or more through-holes defined by theplate member outside the region of overlap; and (C) attaching the regionof overlap of the bone plate to the bone with a threaded fastenerextending along the pivot axis into the bone from the region of overlap.

33. The method of paragraph 32, further comprising a step of adjustingan orientation of the plate members relative to one another before,after, or both before and after the step of attaching each plate memberto bone.

34. The method of paragraph 33, wherein the step of adjusting anorientation of the plate members is performed at least partially afterthe step of placing a bone plate onto a bone.

35. The method of paragraph 34, wherein the step of adjusting anorientation is performed at least partially off bone.

36. The method of any of paragraphs 32 to 35, wherein the step ofattaching the region of overlap includes a step of placing the threadedfastener into threaded engagement with the bone plate.

37. The method of paragraph 36, wherein the step of placing the threadedfastener includes a step of placing the threaded fastener into threadedengagement with an integral portion of one of the plate members.

38. The method of paragraph 37, further comprising a step of placing thehinge joint in a locked configuration by expanding a region of the boneplate with a tapered portion of the threaded fastener.

39. The method of any of paragraphs 36 to 38, wherein the bone plateincludes a connector that is discrete from each of the plate members andthat connects the plate members to one another in the region of overlap,and wherein the step of placing the threaded fastener includes a step ofplacing the threaded fastener into threaded engagement with theconnector.

40. The method of any of paragraphs 32 to 39, further comprising a stepof placing the hinge joint in a fixed configuration that preventspivotal motion of the plate members relative to one another.

41. The method of paragraph 40, wherein the step of attaching isperformed after the step of placing the hinge joint in the fixedconfiguration.

42. The method of paragraph 40 or paragraph 41, wherein the step ofplacing the hinge joint in a fixed configuration includes a step ofturning a connector that pre-connects the plate members to one another.

43. The method of any of paragraphs 32 to 42, wherein the bone is aclavicle.

44. The method of any of paragraphs 32 to 43, wherein the bone plateincludes at least three plate members and at least two hinge joints atwhich the at least three plate members are pre-connected to one anotherpermanently.

45. A method of making a device for bone fixation, the methodcomprising, in any order: (A) placing an integrally formed protrusion ofa first plate member into an opening of a second plate member, eachplate member defining one or more through-holes to receive fasteners toattach the plate member to bone; and (B) deforming the protrusion toprevent removal of the protrusion from the opening and form a pivotableconnection that permits rotation of the plate members relative to oneanother about a pivot axis.

46. A method of making a device for bone fixation, the methodcomprising, in any order: (A) connecting a first plate member to asecond plate member such that the plate members overlap one another at aregion of overlap and are connected to one another in the region ofoverlap with a connector to form a pivotable connection that permitsrotation of the plate members relative to one another about a pivotaxis; and (B) deforming one of the plate members such that removal ofthe connector is prevented.

47. The method of paragraph 46, wherein one of the plate members forms aflange, and wherein the step of deforming includes a step of deformingthe flange.

48. The method of paragraph 47, wherein the connector includes a head,and wherein the step of deforming the flange causes the flange toobstruct travel of the head out of the one plate member.

49. Method of making a device for bone fixation, the method comprisingin any order: (A) placing a deformable region of a connector through anopening of a first plate member and into an opening of a second platemember to form a pivotable connection that permits rotation of the platemembers relative to one another about a pivot axis; wherein thedeformable region is deformed radially inward as the deformable regionenters the opening of the second plate member and then expands radiallyoutward to prevent removal of the connector from the opening of thesecond plate member.

50. The method of paragraph 49, wherein the deformable region includes aplurality of tabs each having a region that projects radially outward.

Example 7. Selected Embodiments III

The following selected embodiments, presented as a series of numberedparagraphs, are intended for illustration and should not limit theentire scope of the present disclosure. Paragraph

1. A method of manufacturing a bone plate, the method comprising, in anyorder: (A) forming one or more through-holes in each of a first platemember and a second plate member, the one or more through-holes beingconfigured to receive one or more fasteners to attach each plate memberto bone; (B) disposing an axle of the second plate member in an aperturedefined by the first plate member; and (C) creating a retainer for theaxle while the axle remains in the aperture; wherein the step ofcreating a retainer permanently connects the plate members to oneanother in a configuration that permits in-plane rotation of the platemembers relative to one another about a pivot axis defined by the axle.

2. The method of paragraph 1, wherein the step of creating a retainerincludes a step of plastically deforming a region of the axle to preventthe region from passing through the aperture.

3. The method of paragraph 1, wherein the step of creating a retainerincludes a step of welding a retainer to the axle.

4. The method of any of paragraphs 1 to 3, wherein the step of creatinga retainer includes a step of tightly engaging the first plate memberwith the retainer.

5. The method of paragraph 4, wherein the step of tightly engagingrenders the plate members resistant to rotation relative to one anotherabout the pivot axis when torque is applied directly to the bone platewith a user's hands.

6. The method of any of paragraphs 1 to 5, wherein the second platemember is formed integrally.

7. The method of any of paragraphs 1 to 6, wherein the step of disposingan axle is performed after the step of forming one or morethrough-holes.

8. The method of any of paragraphs 1 to 7, further comprising a step ofcreating a through-hole that extends through the axle and the retainer.

9. The method of paragraph 8, wherein the step of creating athrough-hole includes a step of creating a through-hole having aninternal thread.

10. The method of paragraph 8 or 9, wherein the step of disposing anaxle includes a step of disposing an axle having a pre-formedthrough-hole, wherein, optionally, the step of creating a through-holeincludes a step of modifying the pre-formed through-hole after the stepof creating a retainer, and wherein, optionally the step of modifyingthe pre-formed through-hole includes a step of creating an internalthread in the pre-formed through-hole.

11. A bone plate for fixing bone, comprising: (A) a first plate memberdefining an aperture; and (B) a second plate member having an axle;wherein each plate member defines one or more through-holes to receiveone or more fasteners to attach the plate member to bone, and whereinthe axle is captured in the aperture such that the first and secondplate members are permanently connected to one another and form a hingejoint that permits in-plane rotation of the plate members relative toone another about a pivot axis defined by the axle.

12. The bone plate of paragraph 11, wherein the second plate memberincludes a body defining the one or more through holes, wherein the axleprojects from the body into the aperture, wherein the second platemember includes a retainer that is continuous with or fused to the axleopposite the body, and wherein the retainer is unable to pass throughthe aperture and is tightly engaged with the first plate member toprevent the hinge joint from moving freely.

13. The bone plate of paragraph 11 or 12, wherein the retainer and theaxle are formed integrally with one another.

14. The bone plate of paragraph 11 or 12, wherein the retainer is weldedto the axle.

15. The bone plate of any of paragraphs 11 to 14, wherein the bone platedefines a through-hole that is coaxial with the pivot axis andconfigured to receive a fastener to attach the hinge joint to bone.

16. The bone plate of paragraph 15, wherein the through-hole that iscoaxial with the pivot axis has an internal thread.

17. The bone plate of any of paragraphs 11 to 16, wherein the hingejoint has an intrinsic resistance to pivotal motion of the plate membersrelative to one another, and wherein the intrinsic resistance isconfigured not to be adjustable off bone.

18. A system comprising the bone plate of paragraph 11, furthercomprising at least one tool to pivot the plate members relative to oneanother about the pivot axis, wherein the at least one tool is longerthan at least one of the plate members.

19. The bone plate of any of paragraphs 11 to 17, wherein one of theplate members is elongated and is marked at its surface to indicate afracture zone of the one plate member for overlap with each fracture ofa bone to be fixed, and wherein the fracture zone extends along only aportion of the length of the one plate member.

20. A method of fixing bone, the method comprising, in any order: (A)selecting a bone plate including a first plate member defining anaperture and a second plate member having an axle that is captured inthe aperture such that the first and second plate members arepermanently connected to one another and form a hinge joint that permitsin-plane rotation of the plate members relative to one another about apivot axis defined by the axle; (B) rotating the plate members relativeto one another about the pivot axis; and (C) attaching each plate memberto a bone with one or more fasteners extending into the bone.

21. The method of paragraph 20, wherein the step of rotating the platemembers is performed before both of the plate members are attached tothe bone.

22. The method of paragraph 20 or 21, wherein the step of attaching eachplate member includes a step of attaching each plate member to aclavicle.

23. The method of any of paragraphs 20 to 22, further comprising a stepof attaching the hinge joint to the bone with a fastener extending intothe bone along the pivot axis from a through-hole defined at least inpart by the axle.

24. The method of any of paragraphs 20 to 23, wherein the step ofrotating the plate members is performed by application of torque withone or more tools engaged with the plate members.

25. The method of paragraph 24, wherein the step of rotating the platemembers includes a step of applying torque with a lever arm that islonger than at least one of the plate members.

26. The method of any of paragraphs 20 to 25, further comprising a stepof making an incision in soft tissue over the bone, a step of placingthe bone plate onto the bone, and a step of closing the incision afterthe steps of rotating the plate members and attaching each plate member,wherein the step of placing the bone plate is performed via theincision, and wherein resistance of the hinge joint to rotation of theplate members about the pivot axis is not adjusted after the step ofrotating the plate members and before the step of closing the incision.

27. A bone plate for fixing bone, comprising: (A) a pair of platemembers overlapping one another at a region of overlap, each platemember defining one or more through-holes outside the region of overlapto receive one or more fasteners to attach the plate member to bone; and(B) a connector that connects the plate members to one another in theregion of overlap to form a hinge joint that permits in-plane rotationof the plate members relative to one another about a pivot axis definedby the connector; wherein the hinge joint is adjustable between amovable configuration and a fixed configuration by manipulation of theconnector, and wherein the connector defines a through-hole that iscoaxial to the pivot axis and configured to receive a fastener thatattaches the region of overlap to bone.

28. The bone plate of paragraph 27, wherein the through-hole that iscoaxial to the pivot axis has an internal thread.

29. The bone plate of paragraph 27 or 28, wherein the plate members arepermanently connected to one another.

30. The bone plate of any of paragraphs 27 to 29, wherein the connectorhas a head and a shaft, and wherein one of the plate members forms aflange that obstructs axial travel of the head out of the bone plate ina direction away from the shaft.

31. The bone plate of any of paragraphs 27 to 30, wherein thethrough-hole defined by the connector has a same inner diameter as atleast one of the through-holes defined outside the region of overlap.

32. The bone plate of any of paragraphs 27 to 31, wherein the bone platehas an inner surface configured to contact bone, wherein the connectorhas a head and a shaft, and wherein the head is under the shaft when theinner surface is facing down.

33. The bone plate of paragraph 32, wherein the shaft has an externalthread that is left-handed.

34. The bone plate of paragraph 33, wherein at least one of the one ormore through-holes has an internal thread that is right-handed.

35. The bone plate of any of paragraphs 27 to 34, wherein the connectoris rotationally fixed with respect to one of the plate members in themovable configuration.

36. The bone plate of any of paragraphs 27 to 35, wherein the connectorhas a shaft defining a plurality of notches.

37. The bone plate of paragraph 36, wherein the notches divide an endregion of the shaft into a plurality of sections, and wherein one ormore of the sections include a locking feature that prevents removal ofthe connector in one direction along the pivot axis.

38. The bone plate of any of paragraphs 27 to 37, wherein the connectorhas a snap-fit connection to one of the plate members.

39. The bone plate of any of paragraphs 27 to 38, wherein each of theplate members is formed integrally.

40. The bone plate of any of paragraphs 27 to 39, wherein one of theplate members forms a track, and wherein an end region of the otherplate member is received in the track.

41. A method of fixing bone, the method comprising, in any order: (A)selecting a bone plate including a pair of plate members overlapping oneanother at a region of overlap and a connector that connects the platemembers to one another in the region of overlap to form a hinge jointhaving a pivot axis defined by the connector; (B) rotating the platemembers relative to one another in-plane about the pivot axis; (C)attaching each plate member to a bone with one or more fastenersextending into the bone from one or more through-holes defined by theplate member outside the region of overlap; and (D) attaching the hingejoint to the bone with a fastener extending into the bone from athrough-hole defined by the connector.

42. The method of paragraph 41, further comprising a step ofmanipulating the connector after the step of rotating the plate membersto fix an orientation of the plate members relative to one another.

43. The method of paragraph 41 or 42, wherein the connector includes anexternal thread, and wherein the step of manipulating the connectorincludes a step of turning the connector about the pivot axis.

44. The method of any of paragraphs 41 to 43, wherein the bone is aclavicle.

45. The method of any of paragraphs 41 to 44, wherein the step ofattaching the hinge joint includes a step of placing a fastener inthreaded engagement with the connector.

46. The method of paragraph 45, wherein the fastener in threadedengagement with the connector has a right-handed external thread, andwherein the connector has a left-handed external thread.

47. The method of any of paragraphs 41 to 46, wherein the step ofrotating the plate members is performed before at least one of the platemembers is attached to bone.

48. The method of any of paragraphs 41 to 47, further comprising a stepof placing the hinge joint in the fixed configuration, wherein the stepof rotating the plate members and the step of placing the hinge joint inthe fixed configuration are performed with the plate members off bone.

49. A bone plate for fixing bone, comprising: (A) a pair of platemembers mated with one another via complementary mating features that(a) allow in-plane rotation of the plate members relative to one anotherabout a pivot axis while the plate members remain mated and (b) preventtranslational disassembly of the mated plate members, each plate memberdefining one or more through-holes to receive one or more fasteners toattach the plate member to bone; and (B) a pin attached to one of theplate members and extending into a slot defined by the other platemember; wherein the pin and the slot define a permitted range ofrotation of the plate members relative to one another about the pivotaxis, and wherein the permitted range of rotation prevents rotationaldisassembly of the mated plate members.

50. The bone plate of paragraph 49, further comprising a threaded memberthat attaches to one of the plate members and is adjustable to preventrotation of the plate members relative to one another about the pivotaxis.

51. The bone plate of paragraph 49 or 50, wherein the plate members arepermanently connected to one another.

52. A method of creating a bone plate, the method comprising, in anyorder: (A) mating a pair of plate members with one another, the platemembers having complementary features such that the mated plate membersare (i) rotatable relative to one another about a pivot axis while theplate members remain mated with one another and (ii) prevented fromtranslational disassembly; and (B) attaching a pin to one of the platemembers such that the pin extends into a slot defined by the other platemember to establish a range of rotation for the plate members thatprevents rotational disassembly of the mated plate members.

53. The method of paragraph 52, wherein the step of mating includes astep of rotationally mating the plate members with one another.

54. The method of paragraph 52, wherein the step of attaching a pinincludes a step of press-fitting the pin into an opening defined by theone plate member.

55. The method of paragraph 52, wherein the step of mating includes astep of placing a boss of one of the plate members in a recess definedby the other plate member, and wherein the boss and the recess are eachcoaxial to the pivot axis after the step of mating.

56. The method of paragraph 55, wherein the step of mating includes astep of rotating the plate members relative to another about the pivotaxis after the step of placing a boss, such that a track of one of theplate members is mated with an end region of the other plate member, andwherein the track mated with the end region prevents disassembly of theplate members from one another in both directions parallel to the pivotaxis.

57. The method of paragraph 56, wherein each of the track and the endregion is arcuate in a plane orthogonal to the pivot axis.

58. The method of paragraph 56, wherein the step of rotating the platemembers includes a step of mating a first track with a first end regionand a second track with a second end region, and wherein the pivot axisis disposed between the first track and end region and the second trackand end region after the step of rotating the plate members.

59. The method of paragraph 58, wherein each track has a center ofcurvature on the pivot axis.

60. A bone plate for fixing bone, comprising: (A) a pair of platemembers overlapping one another at a region of overlap, each platemember defining one or more through-holes outside the region of overlapto receive one or more fasteners to attach the plate member to bone; and(B) a connector attached to one of the plate members in the region ofoverlap to form a hinge joint that permits in-plane rotation of theplate members relative to one another about a pivot axis defined by theconnector; wherein the hinge joint is adjustable between a movableconfiguration and a fixed configuration by manipulation of theconnector, wherein the connector has a head and a shaft, and wherein oneof the plate members obstructs travel of the head out of the bone platein both directions along the pivot axis.

61. The bone plate of paragraph 60, wherein the plate members arepermanently connected to one another.

62. The bone plate of paragraph 60, wherein the bone plate has an innersurface configured to contact bone, and wherein the head is under theshaft when the inner surface is facing down.

63. The bone plate of paragraph 60, wherein the one plate member has aflange that obstructs travel of the head along the pivot axis in adirection away from the shaft.

64. A bone plate for fixing bone, comprising: (A) a pair of platemembers overlapping one another at a region of overlap, each platemember defining one or more through-holes outside the region of overlapto receive one or more fasteners to attach the plate member to bone; and(B) a connector attached to one of the plate members in the region ofoverlap to form a hinge joint that permits in-plane rotation of theplate members relative to one another about a pivot axis defined by theconnector; wherein the hinge joint is adjustable between a movableconfiguration and a fixed configuration by manipulation of theconnector, and wherein the connector is configured not to be removable,such that the plate members are permanently connected to one another.

65. A method of manufacturing a bone plate, the method comprising in anyorder: (A) connecting a pair of plate members to one another with aconnector to form a hinge joint that permits the plate members to rotaterelative to one another in-plane about a pivot axis defined by theconnector, wherein the hinge joint is adjustable between a movableconfiguration and a fixed configuration by manipulation of theconnector; (B) creating one or more through-holes in each plate memberto receive one or more fasteners to attach each plate member to bone;and (C) deforming a region of one of the plate members to preventremoval of the connector, such that the plate members are permanentlyconnected to one another.

66. The method of paragraph 65, wherein the one plate member has aflange projecting from an outer surface or an inner surface of the oneplate member before the step of deforming, and wherein the step ofdeforming includes a step of deforming the flange.

67. The method of paragraph 66, wherein the step of deforming includes astep of deforming at least a portion of the flange toward the pivotaxis.

68. The method of paragraph 66 or 67, wherein the connector has a headand a shaft, and wherein the step of deforming obstructs travel of thehead out of the bone plate along the pivot axis in a direction away fromthe shaft.

69. The method of any of paragraphs 65 to 68, wherein the step ofcreating one or more through-holes is performed before the step ofconnecting.

70. A bone plate for fixing bone, comprising: (A) a first plate memberand a second plate member overlapping one another at a region ofoverlap, each plate member defining one or more through-holes outsidethe region of overlap to receive one or more fasteners to attach theplate member to bone; and (B) a connector that connects the platemembers to one another in the region of overlap to form a joint having(i) a movable configuration that permits changing an orientation of theplate members relative to one another in each of at least twononparallel planes, and (ii) a fixed configuration in which theorientation of the plate members is fixed; wherein the first and secondplate members have respective first and second surface regions that arecomplementary to and face one another, wherein the first plate memberdefines one or more protrusions that are raised with respect to thefirst surface region, wherein the second plate member defines one ormore voids that are recessed with respect to the second surface region,and wherein the one or more protrusions are configured to deform and/orbe deformed by the second plate member when the joint is placed in thefixed configuration, such that at least a portion of each protrusionextends beyond the second surface region into at least one of the one ormore voids.

71. The bone plate of paragraph 70, wherein the first plate member has abody that forms the first surface region, and wherein the one or moreprotrusions are discrete from the body.

72. The bone plate of paragraph 71, wherein the body defines one or morerecesses, wherein the first plate member includes one or more deformableelements that are disposed in the one or more recesses and projecttherefrom to form the one or more protrusions, and wherein the one ormore deformable elements are deformed when the joint is placed in thefixed configuration.

73. The bone plate of paragraph 72, wherein deformation of the one ormore deformable elements is predominant over deformation of the secondplate member when the joint is placed in the fixed configuration.

74. The bone plate of any of paragraphs 71 to 73, wherein the one ormore protrusions are formed of polymer and the first surface region isformed of metal.

75. The bone plate of any of paragraphs 71 to 73, wherein the one ormore protrusions and the first surface region are each formed of metal.

76. The bone plate of any of paragraphs 70 to 75, wherein the secondplate member has a body that forms the second surface region, andwherein the second plate member includes one or more deformable elementsthat are discrete from and attached to the body, and wherein the one ormore deformable elements are deformed by contact with the one or moreprotrusions when the joint is placed in the fixed configuration.

77. The bone plate of paragraph 76, wherein the one or more deformableelements are recessed with respect to the second surface region anddefine at least a portion of each of the one or more voids.

78. The bone plate of paragraph 76, wherein the one or more protrusionsand the second surface region are harder than the one or more deformableelements, such that deformation of the one or more deformable elementsis predominant over deformation of the one or more protrusions and thesecond surface region when the joint is placed in the fixedconfiguration.

79. The bone plate of any of paragraphs 76 to 78, wherein the one ormore protrusions and the first surface region are formed integrally withone another.

80. The bone plate of any of paragraph 70, wherein the one or moreprotrusions and the first surface region are formed integrally with oneanother.

81. The bone plate of paragraph 80, wherein the one or more protrusionsand the at least one void are each deformed when the joint is placed inthe fixed configuration.

82. The bone plate of any of paragraphs 70 to 75, wherein the secondplate member include a same continuous surface that defines each of theone or more voids and forms the second surface region.

83. The bone plate of any of paragraphs 70 to 82, wherein the first andsecond surface regions are engaged with one another in the fixedconfiguration of the joint.

84. The bone plate of any of paragraphs 70 to 82, wherein the one ormore voids have a depth, wherein the one or more protrusions have aheight, and wherein the depth is at least one-fourth of the height.

85. The bone plate of paragraph 84, wherein the depth is equal to orgreater than the height.

86. The bone plate of any of paragraphs 70 to 85, wherein each of theone or more protrusions has a height of at least 0.2 millimeter.

87. The bone plate of paragraph 70 to 86, wherein each of the one ormore voids has a depth of at least 0.2 millimeter.

88. The bone plate of any of paragraphs 70 to 87, wherein the one ormore voids form a pattern.

89. The bone plate of any of paragraphs 70 to 88, wherein the firstsurface region and the one or more protrusions collectively define anarea, and wherein the first surface region constitutes a majority of thearea, and optionally at least 70, 80, or 90% of the area.

90. The bone plate of any of paragraphs 70 to 89, wherein the secondsurface region is composed of a plurality of surface areas that areisolated from one another by the one or more voids.

91. The bone plate of any of paragraphs 70 to 90, wherein eachprotrusion extends beyond the second surface region into the secondplate member in the movable configuration, and wherein each protrusionextends farther into the second plate member in the fixed configurationthan in the movable configuration

92. The bone plate of any of paragraphs 70 to 91, wherein the one ormore protrusions reduce or prevent contact between the first surfaceregion and the second surface region in the movable configuration.

93. The bone plate of paragraph 70, wherein the one or more protrusionsare harder than the first surface region.

94. The bone plate of any of paragraphs 70 to 93, wherein one of theplate members includes a deformable element that is deformed when thejoint is placed in the fixed configuration, and wherein the deformableelement is disposed inside a perimeter of the first or second surfaceregion of the one plate member.

95. The bone plate of any of paragraphs 70 to 94, wherein the secondsurface region and the one or more voids collectively define an area,and wherein the one or more voids constitute a majority of the area.

96. The bone plate of any of paragraphs 70 to 95, wherein at least aportion of each protrusion enters at least one void when the joint isplaced in the fixed configuration from the movable configuration.

97. The bone plate of any of paragraphs 70 to 96, wherein the one ormore voids are formed by milling, sawing, sintering, photo-etching, orelectrical discharge machining.

98. The bone plate of any of paragraphs 70 to 97, wherein each of thefirst and second surface regions defines a sphere having the same radiusof curvature.

99. The bone plate of any of paragraphs 70 to 98, wherein at least oneof the first and second surface regions is not continuous.

100. The bone plate of paragraph 99, wherein the at least one surfaceregion is composed of a plurality of surface areas that are isolatedfrom one another by the one or more protrusions or the one or morevoids.

101. The bone plate of any of paragraphs 70 to 100, wherein the voidsare regularly spaced.

102. The bone plate of any of paragraphs 70 to 101, wherein the voidsintersect one another to form a grid.

103. A bone plate for fixing bone, comprising: (A) a first plate memberand a second plate member overlapping one another at a region ofoverlap, each plate member defining one or more through-holes outsidethe region of overlap to receive one or more fasteners to attach theplate member to bone; and (B) a connector that connects the platemembers to one another in the region of overlap to form a joint having(a) a movable configuration that permits changing an orientation of theplate members relative to one another in at least two nonparallelplanes, and (b) a fixed configuration in which the orientation of theplate members is fixed; wherein the first plate member includes a bodydefining the one or more through-holes and also includes one or morediscrete deformable elements disposed between the body and the secondplate member in the region of overlap, and wherein each deformableelement is configured to be deformed by compressive force applied to thedeformable element by the body of the first plate member and the secondplate member when the joint is placed in the fixed configuration.

104. The bone plate of paragraph 103, wherein the body defines one ormore recesses, and wherein each deformable element is disposed in atleast one of the recesses.

105. The bone plate of paragraph 104, wherein each deformable elementprojects from the at least one recess to form a protrusion.

106. The bone plate of any of paragraphs 103 to 105, wherein the firstand second plate members have respective first and second surfaceregions that are complementary to and face one another in the region ofoverlap, and wherein each deformable element projects from the firstsurface region to form one of the protrusions.

107. The bone plate of any of paragraphs 103 to 106, wherein the platemembers are rotatable relative to one another in the movableconfiguration about an axis defined by the connector.

108. The bone plate of any of paragraphs 103 to 107, wherein theconnector has an external thread.

109. The bone plate of any of paragraphs 103 to 108, wherein the boneplate has an inner surface configured to contact bone, wherein theconnector has a head and a shaft, and wherein the head is below theshaft when the inner surface is facing down.

110. The bone plate of paragraph 109, wherein the external thread isleft-handed.

111. The bone plate of any of paragraphs 103 to 110, wherein the platemembers are rotatable relative to one another in the movableconfiguration in a pair of planes that are orthogonal to one another.

112. The bone plate of any of paragraphs 103 to 111, wherein the firstplate member and the second plate member have respective first andsecond surface regions that are complementary to one another, andwherein the second plate member defines one or more voids that arerecessed with respect to the second surface region.

113. The bone plate of paragraph 112, wherein at least a portion of eachdeformable element extends into at least one of the one or more voids inthe fixed configuration of the joint.

114. The bone plate of any of paragraphs 103 to 113, wherein the firstplate member and the second plate member have respective first andsecond surface regions that are complementary to one another, andwherein the second plate member defines one or more protrusions that areraised with respect to the second surface region, and wherein each ofthe one or more protrusions deforms at least one of the deformableelements when the joint is placed in the fixed configuration.

115. The bone plate of paragraph 114, wherein the one or moreprotrusions include at least one ridge.

116. The bone plate of any of paragraphs 103 to 115, wherein each of theone or more deformable elements is formed of polymer, and wherein thebody is formed of metal.

117. The bone plate of any of paragraphs 103 to 116, wherein the boneplate is configured to be attached to a distal radius.

118. The bone plate of any of paragraphs 103 to 117, wherein a length ofthe bone plate is adjustable when the joint is in the movableconfiguration.

119. A method of fixing bone, the method comprising in any order: (A)attaching the bone plate of paragraph 103 to a bone with fastenersdisposed in the through-holes; (B) changing an orientation of the platemembers relative to one another with the joint in the movableconfiguration; and (C) placing the joint in the fixed configuration.

120. The method of paragraph 119, wherein the step of changing isperformed after the step of attaching, and wherein, optionally, the stepof changing includes a step of applying torque to the bone plate withone or more tools that are engaged with the bone plate.

121. The method of paragraph 119 or 120, wherein the step of attachingthe bone plate includes a step of attaching the bone plate to a distalportion of a radius.

122. The method of any of paragraphs 119 to 121, wherein the bone has adiscontinuity, wherein the step of attaching is performed with the jointoverlapping the discontinuity, and wherein, optionally, thediscontinuity is a fracture.

123. A bone plate for fixing bone, comprising: (A) a first plate memberand a second plate member overlapping one another at a region ofoverlap, each plate member defining one or more through-holes outsidethe region of overlap to receive one or more fasteners to attach theplate member to bone; and (B) a connector that connects the pair ofplate members to one another in the region of overlap to form a jointhaving (i) a movable configuration that permits changing an orientationof the plate members relative to one another in at least two nonparallelplanes, and (ii) a fixed configuration in which the orientation of theplate members is fixed; wherein the first and second plate membersdefine respective first and second apertures in the region of overlap,wherein the connector extends from the first aperture to the secondaperture, wherein the first plate member defines a projection that isreceived in the second aperture, and wherein the projection and thesecond aperture collectively define a range for the orientation in eachof the nonparallel planes.

124. The bone plate of paragraph 123, wherein the first aperture extendsthrough the projection.

125. The bone plate of paragraph 123 or 124, wherein the projection iscentered on the first aperture.

126. The bone plate of any of paragraphs 123 to 125, wherein theconnector has a head and a shaft, and wherein portions of the shaft aredisposed in the first aperture and the second aperture.

127. The bone plate of any of paragraphs 123 to 126, wherein the secondaperture has an internal thread for threaded engagement with an externalthread of the connector.

128. The bone plate of any of paragraphs 123 to 127, wherein the firstplate member has an inner or an outer surface that faces the secondplate member, wherein the first aperture has a region of minimum widththat prevents a head of the connector from passing through the firstaperture, and wherein the first aperture widens as it extends from theregion of minimum width to the inner or outer surface, to form areceiver for the projection.

129. The bone plate of paragraph 128, wherein the outer surface of thefirst plate member faces the second plate member, and wherein the headof the connector is disposed below the region of minimum width when theouter surface is facing up.

130. The bone plate of any of paragraphs 123 to 129, wherein theconnector has a shaft with an external thread that is left-handed.

131. The bone plate of any of paragraphs 128 to 130, wherein theconnector defines an axis, and wherein each of the receiver and theprojection has a perimeter wall that is within 30 degrees of parallel tothe axis.

132. The bone plate of any of paragraphs 123 to 131, wherein a wall ofthe first aperture limits rotation of the projection about an axisdefined by the connector in the movable configuration of the joint.

133. The bone plate of paragraph 132, wherein the projection has a rangeof angular motion of less than 60, 45, or 30 degrees about the axisdefined by the connector.

134. A bone plate for fixing bone, comprising: (A) a pair of platemembers overlapping one another at a region of overlap, each platemember defining one or more through-holes outside the region of overlapto receive one or more fasteners to attach the plate member to bone; and(B) a connector that connects the pair of plate members to one anotherin the region of overlap to form a joint having (i) a movableconfiguration that permits changing an orientation of the plate membersrelative to one another continuously in a first plane and in discreteincrements in a second plane that is transverse to the first plane, and(ii) a fixed configuration in which the orientation of the plate membersis fixed.

135. The bone plate of paragraph 134, wherein one of the plate membersincludes a series of openings, and wherein the other plate memberincludes an edge region configured to be interchangeably received ineach of the openings to provide the discrete increments by which theorientation is changed in the second plane.

136. The bone plate of paragraph 134 or 135, wherein one of the platemembers includes a series of teeth, and wherein the other plate memberincludes an edge region configured to be interchangeably receivedbetween successive pairs of the teeth to provide the discrete incrementsby which the orientation is changed in the second plane.

137. The bone plate of any of paragraphs 135 or 136, wherein the edgeregion forms part of a perimeter of the one plate member.

138. The bone plate of any of paragraphs 135 to 137, wherein the edgeregion is arcuate in the first plane.

139. The bone plate of any of paragraphs 135, 137, and 138, wherein eachopening is arcuate in the first plane.

140. The bone plate of any of paragraphs 134 to 139, wherein one of theplate members includes a tab that helps to define a range of motion ofthe plate members relative to one another in the first plane.

141. The bone plate of paragraph 140, wherein the tab is visible fromabove the bone plate and indicates the orientation in the first plane.

142. The bone plate of paragraph 140 or 141, wherein the tab is receivedin a slot defined by the other plate member, and wherein contact of thetab with a wall of the slot defines the range of motion in the firstplane.

143. The bone plate of any of paragraphs 134 to 142, wherein the boneplate includes a ratchet that permits the orientation to be changed bythe discrete increments.

144. A bone plate for fixing bone, comprising: (A) a first plate memberforming a first joint surface defining one or more protrusions; (B) asecond plate member defining one or more voids; and (C) a connector thatconnects the plate members to one another with the joint surfaces facingone another, to form a joint having (i) a movable configuration thatpermits changing an orientation of the plate members relative to oneanother in each of at least two nonparallel planes, and (ii) a fixedconfiguration in which the orientation of the plate members is fixed;wherein the one or more protrusions are configured to deform and/or bedeformed by the second joint surface when the joint is placed in thefixed configuration, such that at least a portion of each protrusionenters least one of the voids.

The disclosure set forth above may encompass multiple distinctinventions with independent utility. Although each of these inventionshas been disclosed in its preferred form(s), the specific embodimentsthereof as disclosed and illustrated herein are not to be considered ina limiting sense, because numerous variations are possible. The subjectmatter of the inventions includes all novel and nonobvious combinationsand subcombinations of the various elements, features, functions, and/orproperties disclosed herein. The following claims particularly point outcertain combinations and subcombinations regarded as novel andnonobvious. Inventions embodied in other combinations andsubcombinations of features, functions, elements, and/or properties maybe claimed in applications claiming priority from this or a relatedapplication. Such claims, whether directed to a different invention orto the same invention, and whether broader, narrower, equal, ordifferent in scope to the original claims, also are regarded as includedwithin the subject matter of the inventions of the present disclosure.Further, ordinal indicators, such as first, second, or third, foridentified elements are used to distinguish between the elements, and donot indicate a particular position or order of such elements, unlessotherwise specifically stated.

We claim:
 1. A bone plate for fixing bone, comprising: a first platemember and a second plate member overlapping one another at a region ofoverlap, each plate member defining one or more through-holes outsidethe region of overlap to receive one or more fasteners to attach theplate member to bone; and a connector that connects the plate members toone another in the region of overlap to form a joint having (a) amovable configuration that permits changing an orientation of the platemembers relative to one another in at least two nonparallel planes, and(b) a fixed configuration in which the orientation of the plate membersis fixed; wherein the first plate member includes a body defining theone or more through-holes and also includes one or more discretedeformable elements disposed between the body and the second platemember in the region of overlap, and wherein each deformable element isconfigured to be deformed by compressive force applied to the deformableelement by the body of the first plate member and the second platemember when the joint is placed in the fixed configuration.
 2. The boneplate of claim 1, wherein the body defines one or more recesses, andwherein each deformable element is disposed in at least one of therecesses.
 3. The bone plate of claim 2, wherein each deformable elementprojects from the at least one recess to form a protrusion.
 4. The boneplate of claim 1, wherein the first plate member and the second platemember have respective first and second surface regions that arecomplementary to one another, and wherein the second plate memberdefines one or more voids that are recessed with respect to the secondsurface region.
 5. The bone plate of claim 4, wherein at least a portionof each deformable element is disposed in at least one of the one ormore voids in the fixed configuration of the joint.
 6. A bone plate forfixing bone, comprising: a first plate member and a second plate memberoverlapping one another at a region of overlap, each plate memberdefining one or more through-holes outside the region of overlap toreceive one or more fasteners to attach the plate member to bone; and aconnector that connects the plate members to one another in the regionof overlap to form a joint having (a) a movable configuration thatpermits changing an orientation of the plate members relative to oneanother in each of at least two nonparallel planes, and (b) a fixedconfiguration in which the orientation of the plate members is fixed;wherein the first and second plate members have respective first andsecond surface regions that are complementary to and face one another,wherein the first plate member defines one or more protrusions that areraised with respect to the first surface region, wherein the secondplate member defines one or more voids that are recessed with respect tothe second surface region, and wherein the one or more protrusions areconfigured to deform and/or be deformed by the second plate member whenthe joint is placed in the fixed configuration, such that at least aportion of each protrusion extends beyond the second surface region intoat least one of the one or more voids.
 7. The bone plate of claim 6,wherein the first plate member has a body that forms the first surfaceregion, and wherein the one or more protrusions are discrete from thebody.
 8. The bone plate of claim 7, wherein the body defines one or morerecesses, wherein the first plate member includes one or more discretedeformable elements that are disposed in the one or more recesses andproject therefrom to form the one or more protrusions, and wherein theone or more deformable elements are deformed when the joint is placed inthe fixed configuration.
 9. The bone plate of claim 6, wherein thesecond plate member has a body that forms the second surface region, andwherein the second plate member includes one or more deformable elementsthat are discrete from and attached to the body, and wherein the one ormore deformable elements are deformed by contact with the one or moreprotrusions when the joint is placed in the fixed configuration.
 10. Thebone plate of claim 9, wherein the one or more deformable elements arerecessed with respect to the second surface region and define at least aportion of each of the one or more voids.
 11. The bone plate of claim 6,wherein the one or more protrusions and the first surface region areformed integrally with one another.
 12. The bone plate of claim 6,wherein the first and second surface regions are engaged with oneanother in the fixed configuration of the joint.
 13. The bone plate ofclaim 6, wherein the one or more voids have a depth, wherein the one ormore protrusions have a height, and wherein the depth is at leastone-fourth of the height.
 14. The bone plate of claim 13, wherein thedepth is equal to or greater than the height.
 15. The bone plate ofclaim 6, wherein each of the one or more protrusions has a height of atleast 0.2 millimeter, and wherein each of the one or more voids has adepth of at least 0.2 millimeter.
 16. The bone plate of claim 6, whereinthe one or more protrusions reduce or prevent contact between the firstsurface region and the second surface region in the movableconfiguration.
 17. The bone plate of claim 6, wherein the second surfaceregion and the one or more voids collectively define an area, andwherein the one or more voids constitute a majority of the area.
 18. Thebone plate of claim 6, wherein at least a portion of each protrusionenters at least one void when the joint is placed in the fixedconfiguration from the movable configuration.
 19. The bone plate ofclaim 6, wherein at least one of the first and second surface regions isnot continuous, and wherein the at least one surface region is composedof a plurality of surface areas that are isolated from one another bythe one or more protrusions or the one or more voids.